| NPI | 1386411775 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: ME LC22078) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MA LICSW126) |
| Enumeration Date | 2023-12-06 |
| Last Update Date | 2023-12-06 |