| NPI | 1720195951 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: OR 1077) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MN 30378) |
| Enumeration Date | 2006-08-24 |
| Last Update Date | 2024-10-15 |