| NPI | 1770569907 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: MN 17219) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: MN LP17219) |
| Enumeration Date | 2005-12-20 |
| Last Update Date | 2020-09-28 |