| NPI | 1033758321 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: ME LC20186) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical |
| Enumeration Date | 2020-01-03 |
| Last Update Date | 2022-06-21 |