| NPI | 1124572300 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: ME LC17610) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: ME MC16201) |
| Enumeration Date | 2016-08-05 |
| Last Update Date | 2023-11-03 |