| NPI | 1962055467 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: MI 6851110012) |
| Additional Taxonomies | 104100000X Social Worker (Licence: MI 6801110012) |
| 247200000X | |
| Enumeration Date | 2019-07-23 |
| Last Update Date | 2021-08-18 |