| NPI | 1053418673 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: ME LC11480) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: PA CW017194) |
| 1041C0700X Social Worker, Clinical (Licence: NY R055887) | |
| Enumeration Date | 2006-09-17 |
| Last Update Date | 2022-06-28 |