| NPI | 1720732837 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MN 27753) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: TX 106834) |
| Enumeration Date | 2022-02-08 |
| Last Update Date | 2024-10-29 |