| NPI | 1114668829 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MN 29410) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: WI 11755-123) |
| Enumeration Date | 2022-04-05 |
| Last Update Date | 2024-05-31 |