| NPI | 1962905364 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: LA 16652) |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator (Licence: LA 16652) |
| Enumeration Date | 2018-03-12 |
| Last Update Date | 2023-02-05 |