| NPI | 1376123158 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: ME LC22294) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: ME MC19011) |
| Enumeration Date | 2021-04-14 |
| Last Update Date | 2023-04-26 |