| NPI | 1386396091 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MN 30198) |
| Additional Taxonomies | 104100000X Social Worker (Licence: MN 30198) |
| Enumeration Date | 2022-01-24 |
| Last Update Date | 2023-08-15 |