| NPI | 1518470228 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: UT 10500505-3502) |
| Additional Taxonomies | 104100000X Social Worker (Licence: MO 2017017828) |
| Enumeration Date | 2017-11-16 |
| Last Update Date | 2022-01-13 |