| 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 |