| NPI | 1811266505 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: MO 2011041274) |
| Additional Taxonomies | 104100000X Social Worker (Licence: SD 2915) |
| Enumeration Date | 2011-12-25 |
| Last Update Date | 2011-12-25 |