| NPI | 1184131823 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 104100000X Social Worker (Licence: MN 34621) | 
| Additional Taxonomies | 104100000X Social Worker (Licence: LA 14671) | 
| Enumeration Date | 2018-01-03 | 
| Last Update Date | 2025-08-06 |