| NPI | 1235282427 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MN 29799) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: AZ LCSW-12335) |
| Enumeration Date | 2007-01-19 |
| Last Update Date | 2022-01-20 |