| NPI | 1346386646 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: MA 102491) |
| Additional Taxonomies | 104100000X Social Worker (Licence: CT 005106) |
| 104100000X Social Worker (Licence: RI ISW00021) | |
| Enumeration Date | 2007-01-30 |
| Last Update Date | 2025-02-18 |