| NPI | 1700568763 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: SC 16258) |
| Additional Taxonomies | 104100000X Social Worker (Licence: WI 132632) |
| Enumeration Date | 2023-08-01 |
| Last Update Date | 2023-08-01 |