| NPI | 1730832007 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: MD 29605) |
| Additional Taxonomies | 104100000X Social Worker (Licence: MA 227635) |
| Enumeration Date | 2022-01-27 |
| Last Update Date | 2023-04-03 |