| NPI | 1144997164 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: MO 2021050526) |
| Additional Taxonomies | 104100000X Social Worker (Licence: KS LMSW12349) |
| Enumeration Date | 2021-08-26 |
| Last Update Date | 2023-12-04 |