| NPI | 1770917072 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker |
| Additional Taxonomies | 3747P1801X Technician, Personal Care Attendant (Licence: MN PCA30821820130822) |
| Enumeration Date | 2013-08-23 |
| Last Update Date | 2019-03-21 |