| NPI | 1942578091 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical |
| Additional Taxonomies | 104100000X Social Worker (Licence: MN 19320) |
| 1041C0700X Social Worker, Clinical (Licence: MN 19320) | |
| Enumeration Date | 2011-12-05 |
| Last Update Date | 2025-08-15 |