| NPI | 1003257825 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: ME LC15393) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: ME MC14221) |
| Enumeration Date | 2013-07-09 |
| Last Update Date | 2026-06-17 |