| NPI | 1487987590 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: ND 4392) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MN 31615) |
| Enumeration Date | 2009-09-09 |
| Last Update Date | 2025-10-28 |