| NPI | 1356092233 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MT BBH-LCSW-LIC-57394) |
| Additional Taxonomies | 104100000X Social Worker (Licence: MT 39008) |
| Enumeration Date | 2022-01-12 |
| Last Update Date | 2022-11-14 |