| NPI | 1134798721 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MT BBH-LCSW-LIC-70695) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: ID LCSW-37560) |
| Enumeration Date | 2021-06-18 |
| Last Update Date | 2024-11-12 |