| NPI | 1083229082 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: ND 5553) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MN 26214) |
| Enumeration Date | 2020-09-15 |
| Last Update Date | 2023-08-03 |