| NPI | 1760490114 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: NC C009558) |
| Additional Taxonomies | 104100000X Social Worker (Licence: MS C5477) |
| Enumeration Date | 2006-08-03 |
| Last Update Date | 2015-12-23 |