| NPI | 1083090757 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CO CSW.09925529) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: ME LC16871) |
| Enumeration Date | 2015-08-05 |
| Last Update Date | 2024-09-19 |