| NPI | 1982024501 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: WY LCSW-821) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: UT 328017-3501) |
| Enumeration Date | 2014-04-22 |
| Last Update Date | 2015-06-04 |