| NPI | 1275819666 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MN 32379) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: IL 149.014964) |
| Enumeration Date | 2011-10-29 |
| Last Update Date | 2024-08-13 |