| NPI | 1275291866 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 104100000X Social Worker (Licence: DC LG200003037) | 
| Additional Taxonomies | 104100000X Social Worker (Licence: PA SW140340) | 
| Enumeration Date | 2021-12-01 | 
| Last Update Date | 2025-02-25 |