| NPI | 1285266221 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MT BBH-LCSW-42585) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: BBH-LCSW-42585) |
| 1041C0700X Social Worker, Clinical (Licence: MT 42585) | |
| Enumeration Date | 2020-02-07 |
| Last Update Date | 2020-03-19 |