| NPI | 1679058127 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: MN 27646) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical |
| Enumeration Date | 2018-10-01 |
| Last Update Date | 2021-04-23 |