| NPI | 1245601004 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: GA MSW008122) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NY 094501-1) |
| Enumeration Date | 2015-10-19 |
| Last Update Date | 2018-10-16 |