| NPI | 1164800439 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: DC LG50078801) |
| Additional Taxonomies | 104100000X Social Worker (Licence: MD 13982) |
| Enumeration Date | 2015-05-07 |
| Last Update Date | 2026-06-02 |