| NPI | 1336752443 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: ND 5729) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MN 28913) |
| Enumeration Date | 2020-08-28 |
| Last Update Date | 2024-10-28 |