| NPI | 1508693086 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MT BBH-SWLC-LIC-72638) |
| Additional Taxonomies | 174H00000X Health Educator (Licence: MT BBH-SWLC-LIC-72638) |
| 171M00000X Case Manager/Care Coordinator (Licence: MT BBH-SWLC-LIC-72638) | |
| Enumeration Date | 2024-09-18 |
| Last Update Date | 2025-12-15 |