| NPI | 1033286414 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: MN 12688) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: MN 300215) |
| Enumeration Date | 2006-11-29 |
| Last Update Date | 2009-08-12 |