| NPI | 1447989272 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: MN 26000) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: SD 5185) |
| Enumeration Date | 2022-06-07 |
| Last Update Date | 2025-02-17 |