| NPI | 1457311789 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MN 20659) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: ID LCSW26297) |
| Enumeration Date | 2006-03-23 |
| Last Update Date | 2026-02-17 |