| NPI | 1144700717 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: ME LC21931) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: ME MC19093) |
| Enumeration Date | 2018-08-14 |
| Last Update Date | 2024-07-29 |