| NPI | 1093329294 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: ME LC19443) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MA 123046) |
| 1041C0700X Social Worker, Clinical (Licence: ME MC17118) | |
| Enumeration Date | 2020-09-04 |
| Last Update Date | 2020-12-07 |