| NPI | 1659146678 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: TN 13904) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MA 230130) |
| Enumeration Date | 2023-11-20 |
| Last Update Date | 2025-05-05 |