| NPI | 1669900452 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MN 26323) |
| Additional Taxonomies | 104100000X Social Worker (Licence: MN 26323) |
| 171M00000X Case Manager/Care Coordinator | |
| Enumeration Date | 2017-05-24 |
| Last Update Date | 2021-01-04 |