| NPI | 1194182444 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 251S00000X (Licence: ME LC16924) |
| Additional Taxonomies | 104100000X Social Worker (Licence: ME MC15799) |
| 1041C0700X Social Worker, Clinical (Licence: ME LC16924) | |
| Enumeration Date | 2016-01-18 |
| Last Update Date | 2024-05-30 |