| NPI | 1386184679 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: WI 11312) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NY 096387) |
| Enumeration Date | 2017-03-06 |
| Last Update Date | 2023-07-13 |