| NPI | 1669053443 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: AZ LMSW-18808) |
| Additional Taxonomies | 104100000X Social Worker (Licence: WA SC61127538) |
| Enumeration Date | 2021-04-14 |
| Last Update Date | 2021-04-14 |