| NPI | 1629590179 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: MT BBH-SWLC-LIC-19414) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MT BBH-LCSW-LIC-39132) |
| Enumeration Date | 2017-07-15 |
| Last Update Date | 2021-09-10 |