| NPI | 1114053634 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041S0200X Social Worker, School (Licence: ME LC1366) |
| Additional Taxonomies | 104100000X Social Worker (Licence: ME LC1366) |
| 1041C0700X Social Worker, Clinical (Licence: ME LC1366) | |
| Enumeration Date | 2007-02-26 |
| Last Update Date | 2025-09-11 |