| NPI | 1437581329 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MN 22564) |
| Additional Taxonomies | 104100000X Social Worker (Licence: MN 22564) |
| Enumeration Date | 2013-08-02 |
| Last Update Date | 2018-03-17 |