| NPI | 1770144693 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: LA 4589) |
| Additional Taxonomies | 104100000X Social Worker |
| 171M00000X Case Manager/Care Coordinator (Licence: LA 4837) | |
| Enumeration Date | 2019-06-21 |
| Last Update Date | 2019-08-27 |