| NPI | 1952345639 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 104100000X Social Worker (Licence: MN 3977) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: MN 3977) |
| Enumeration Date | 2006-06-15 |
| Last Update Date | 2007-07-09 |