| NPI | 1902563059 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: UT 14244174-3503) |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator (Licence: UT F22-103592) |
| Enumeration Date | 2021-11-23 |
| Last Update Date | 2025-10-17 |