| NPI | 1265813224 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: ME LC16712) |
| Additional Taxonomies | 104100000X Social Worker (Licence: ME ME15464) |
| Enumeration Date | 2015-06-16 |
| Last Update Date | 2022-01-11 |