| NPI | 1689321291 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MN 30251) |
| Additional Taxonomies | 104100000X Social Worker (Licence: MN 30251) |
| Enumeration Date | 2022-03-03 |
| Last Update Date | 2025-03-04 |