| NPI | 1710310917 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MN 21564) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: ND 6695) |
| Enumeration Date | 2013-08-12 |
| Last Update Date | 2024-02-28 |