| NPI | 1366316291 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: OH S.2512966) |
| Additional Taxonomies | 104100000X Social Worker (Licence: IA 130912) |
| 104100000X Social Worker (Licence: CT 11655) | |
| Enumeration Date | 2025-10-02 |
| Last Update Date | 2025-11-14 |