| NPI | 1700422003 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: NM M-10997) |
| Additional Taxonomies | 1041S0200X Social Worker, School (Licence: NM 391830) |
| Enumeration Date | 2019-11-21 |
| Last Update Date | 2019-11-21 |