| NPI | 1336515030 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MN 27480) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: OH I1500474) |
| Enumeration Date | 2015-08-17 |
| Last Update Date | 2018-10-26 |