| NPI | 1851985352 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: OR L10612) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical |
| 1041C0700X Social Worker, Clinical (Licence: MT BBH-LCSW-LIC-631135) | |
| Enumeration Date | 2021-02-24 |
| Last Update Date | 2026-09-09 |