| NPI | 1205917341 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: MN 12301) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: MN 12301SOCIALWORK) |
| Enumeration Date | 2006-10-17 |
| Last Update Date | 2014-07-02 |