| NPI | 1255462321 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: MN 25289) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: ME LC11157) |
| Enumeration Date | 2007-03-08 |
| Last Update Date | 2022-07-21 |