| NPI | 1912799552 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: OR A16158) |
| Additional Taxonomies | 104100000X Social Worker (Licence: ID 4071969) |
| Enumeration Date | 2025-05-20 |
| Last Update Date | 2026-08-05 |