NPI | 1962505974 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MN 2005003664) |
Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MO 2005003664) |
Enumeration Date | 2006-09-06 |
Last Update Date | 2012-02-21 |