| NPI | 1114037652 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: ME LC7005) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: ME LC7005) |
| Enumeration Date | 2006-08-30 |
| Last Update Date | 2009-01-07 |