| NPI | 1275298531 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MN 31296) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MT BBH-LCSW-LIC-50627) |
| Enumeration Date | 2021-11-02 |
| Last Update Date | 2023-04-16 |