| NPI | 1013383629 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: ME LC16888) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: ME MC15483) |
| Enumeration Date | 2015-08-18 |
| Last Update Date | 2020-04-07 |