| NPI | 1003433921 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: MN 23667) |
| Additional Taxonomies | 104100000X Social Worker (Licence: TX 69153) |
| Enumeration Date | 2020-06-26 |
| Last Update Date | 2021-08-09 |