| NPI | 1972985927 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: WA LW60845284) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NM M-09253) |
| 104100000X Social Worker (Licence: NM X-09165) | |
| Enumeration Date | 2015-06-26 |
| Last Update Date | 2021-11-12 |