| NPI | 1558751933 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MN 26533) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: SD 5251) |
| Enumeration Date | 2015-01-23 |
| Last Update Date | 2026-08-25 |