| NPI | 1831457258 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WY LCSW-928) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: ID LCSW-38968) |
| 104100000X Social Worker (Licence: UT 8587228-3501) | |
| Enumeration Date | 2012-04-24 |
| Last Update Date | 2026-07-22 |