| NPI | 1225107808 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MN 305) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MN 00305) |
| Enumeration Date | 2006-11-07 |
| Last Update Date | 2016-09-16 |