| NPI | 1982051579 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WY lcsw993) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CO 992444) |
| Enumeration Date | 2016-05-24 |
| Last Update Date | 2016-05-24 |