| NPI | 1790363315 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 104100000X Social Worker (Licence: FL ISW15297) | 
| Additional Taxonomies | 104100000X Social Worker (Licence: AL 5185G) | 
| Enumeration Date | 2021-04-02 | 
| Last Update Date | 2021-04-02 |