| NPI | 1235657073 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: ND 5244) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MN 32045) |
| Enumeration Date | 2017-08-31 |
| Last Update Date | 2025-07-02 |