| NPI | 1477647576 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MN 10929) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: ND 2650) |
| Enumeration Date | 2006-10-03 |
| Last Update Date | 2011-10-04 |