| NPI | 1558937276 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MN 32073) |
| Additional Taxonomies | 104100000X Social Worker (Licence: UT 12326769-3501) |
| 104100000X Social Worker (Licence: MN 32073) | |
| Enumeration Date | 2021-06-02 |
| Last Update Date | 2024-01-09 |