| NPI | 1164978961 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: SC 11706) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NC P0105577) |
| Enumeration Date | 2016-08-31 |
| Last Update Date | 2016-08-31 |