| NPI | 1255698205 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WI 8473) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MN 21082) |
| Enumeration Date | 2012-04-16 |
| Last Update Date | 2025-06-16 |