| NPI | 1881046571 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MN LICSW 25446) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: AZ LCSW-16088) |
| Enumeration Date | 2016-07-06 |
| Last Update Date | 2022-12-20 |