| NPI | 1407680523 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MN 26782) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: WI 12856-123) |
| Enumeration Date | 2024-08-30 |
| Last Update Date | 2026-03-29 |