| NPI | 1033661491 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: ME LC20823) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CO csw09924232) |
| Enumeration Date | 2016-11-01 |
| Last Update Date | 2023-10-24 |