| NPI | 1043554207 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MN 20003) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: ND 6574) |
| Enumeration Date | 2012-11-11 |
| Last Update Date | 2024-06-24 |