NPI | 1689187403 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MT BBH-LCSW-LIC-767) |
Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MT 767) |
Enumeration Date | 2017-11-15 |
Last Update Date | 2017-11-15 |