| NPI | 1366107005 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: ME MC20109) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: ME LC25105) |
| Enumeration Date | 2021-11-08 |
| Last Update Date | 2025-09-03 |