| NPI | 1467134593 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MN 31954) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NV 10962-C.) |
| Enumeration Date | 2023-08-07 |
| Last Update Date | 2026-03-21 |