| NPI | 1346962859 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MN 34430) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: WA LW61567836) |
| Enumeration Date | 2022-09-13 |
| Last Update Date | 2025-05-22 |