| NPI | 1689885451 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MN 1678) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: WI 6892-123) |
| Enumeration Date | 2007-05-24 |
| Last Update Date | 2024-06-13 |