| NPI | 1790267334 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: KY 253446) |
| Additional Taxonomies | 104100000X Social Worker (Licence: IN 33009076A) |
| Enumeration Date | 2018-08-30 |
| Last Update Date | 2019-05-01 |