| NPI | 1821602103 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: MI 6801115881) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NY 110200) |
| Enumeration Date | 2020-09-03 |
| Last Update Date | 2023-07-17 |