| NPI | 1336171016 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MN 22228) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NY 068669-1) |
| Enumeration Date | 2006-07-06 |
| Last Update Date | 2026-05-26 |