| NPI | 1023125242 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: ME 272-LCPC) |
| Additional Taxonomies | 104100000X Social Worker (Licence: ME 741-LPE) |
| Enumeration Date | 2006-08-24 |
| Last Update Date | 2007-07-08 |