| NPI | 1619678745 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: LA 15564) |
| Additional Taxonomies | 104100000X Social Worker (Licence: TX 109070) |
| Enumeration Date | 2023-03-15 |
| Last Update Date | 2024-04-10 |