| NPI | 1235554627 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: ME LC12519) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: ME LC12519) |
| Enumeration Date | 2014-02-21 |
| Last Update Date | 2023-01-27 |