| NPI | 1265003115 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: SD 5252) |
| Additional Taxonomies | 104100000X Social Worker (Licence: KY 25547) |
| Enumeration Date | 2021-07-01 |
| Last Update Date | 2021-07-01 |