| NPI | 1336335637 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MN 25255) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CO CSW.09923746) |
| Enumeration Date | 2007-09-20 |
| Last Update Date | 2024-07-20 |