| NPI | 1538961750 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MN 10809) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: OR L16409) |
| Enumeration Date | 2025-03-26 |
| Last Update Date | 2025-09-22 |