| NPI | 1376186353 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: MA 228613) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NY 116996) |
| Enumeration Date | 2019-10-23 |
| Last Update Date | 2023-01-18 |