| NPI | 1912279423 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: ND 5645) |
| Additional Taxonomies | 104100000X Social Worker (Licence: ID 31853) |
| 1041C0700X Social Worker, Clinical (Licence: WY PCSW-638) | |
| 1041C0700X Social Worker, Clinical (Licence: WY LCSW-994) | |
| Enumeration Date | 2012-01-30 |
| Last Update Date | 2020-03-16 |