| NPI | 1811343866 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: MN 22769) |
| Additional Taxonomies | 1041S0200X Social Worker, School (Licence: MN 476865) |
| Enumeration Date | 2016-05-09 |
| Last Update Date | 2018-05-01 |