| NPI | 1720453715 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MN 33414) |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator (Licence: FL 14449) |
| Enumeration Date | 2015-12-02 |
| Last Update Date | 2024-06-26 |