| NPI | 1659862795 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical |
| Additional Taxonomies | 104100000X Social Worker (Licence: MT BBH-LCSW-LIC-30556) |
| Enumeration Date | 2018-05-24 |
| Last Update Date | 2019-06-14 |