| NPI | 1710393012 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 081880) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MN AP14-1068) |
| Enumeration Date | 2014-07-08 |
| Last Update Date | 2014-07-08 |