Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | 1975 | MN |
NPI | 1003262817 |
---|---|
Provider Name | Mr. Phillip Ernest Larkins |
First Address | Brooklyn Park, MN 55443-2378 |
Second Address | Brooklyn Park, MN 55443-2378 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/05/2016 |
Last Update Date | 11/05/2016 |