| NPI | 1700610649 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: NV 12608-M) |
| Additional Taxonomies | 225400000X Rehabilitation Practitioner |
| Enumeration Date | 2024-08-30 |
| Last Update Date | 2025-09-15 |