| NPI | 1992802714 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MN 33619) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NH 983) |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2025-08-14 |