| NPI | 1477942589 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: TX 59628) |
| Additional Taxonomies | 104100000X Social Worker (Licence: ID LSW 29631) |
| Enumeration Date | 2015-01-13 |
| Last Update Date | 2015-01-13 |