| NPI | 1861186322 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 104100000X Social Worker (Licence: DC LG500083416) | 
| Additional Taxonomies | 104100000X Social Worker (Licence: MD LG500083416) | 
| Enumeration Date | 2023-06-07 | 
| Last Update Date | 2023-06-07 |