| NPI | 1417353236 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MN 16778) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MN 302559) |
| Enumeration Date | 2014-11-05 |
| Last Update Date | 2019-12-12 |