| NPI | 1093293326 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MN 27303) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: WI 9522) |
| Enumeration Date | 2018-07-30 |
| Last Update Date | 2024-01-30 |