| NPI | 1033819776 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: ME LC23926) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: ME MC21308) |
| Enumeration Date | 2023-03-09 |
| Last Update Date | 2024-08-16 |