| NPI | 1962898981 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MN LICSW30386) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CA LCSW75654) |
| Enumeration Date | 2015-04-07 |
| Last Update Date | 2026-03-14 |