| NPI | 1003170838 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MN 5416) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: AZ 13543) |
| Enumeration Date | 2012-06-26 |
| Last Update Date | 2012-06-26 |