| NPI | 1992283618 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: MN 30701) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: UT 14194009-3501) |
| Enumeration Date | 2018-08-03 |
| Last Update Date | 2025-08-22 |