| NPI | 1235358037 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MN 7483) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: MN 1449) |
| Enumeration Date | 2007-04-24 |
| Last Update Date | 2020-02-25 |