| NPI | 1003201740 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: MO 2015009728) |
| Additional Taxonomies | 104100000X Social Worker (Licence: KS 9362) |
| Enumeration Date | 2015-03-31 |
| Last Update Date | 2015-03-31 |