| NPI | 1437720133 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MN 29702) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: ND 6072) |
| Enumeration Date | 2021-07-05 |
| Last Update Date | 2021-07-05 |