| NPI | 1194253385 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: ME LC21487) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NY 089953) |
| Enumeration Date | 2017-06-01 |
| Last Update Date | 2023-12-14 |