| NPI | 1861786360 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WY LCSW-1548) |
| Additional Taxonomies | 172V00000X Community Health Worker |
| 1041C0700X Social Worker, Clinical | |
| 171M00000X Case Manager/Care Coordinator | |
| Enumeration Date | 2011-06-02 |
| Last Update Date | 2026-03-11 |