| NPI | 1063431971 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: ME LC6714) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: ME LC6714) |
| 101YP2500X Counselor, Professional (Licence: ME LC6714) | |
| Enumeration Date | 2006-07-19 |
| Last Update Date | 2018-04-20 |