| NPI | 1558342519 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MN 13477) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: WI 7917) |
| Enumeration Date | 2005-11-08 |
| Last Update Date | 2020-05-07 |