| NPI | 1346751740 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: ME LC18546) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: ME MC16853) |
| Enumeration Date | 2017-10-12 |
| Last Update Date | 2020-02-28 |