| NPI | 1003213299 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: MN 21133) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MN 2113) |
| Enumeration Date | 2014-12-03 |
| Last Update Date | 2020-12-31 |