| NPI | 1972130896 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: CT 11711) |
| Additional Taxonomies | 104100000X Social Worker (Licence: CT 5165) |
| Enumeration Date | 2020-03-23 |
| Last Update Date | 2021-09-20 |