| NPI | 1396960100 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: FL 9768) |
| Additional Taxonomies | 104100000X Social Worker (Licence: ME LC10384) |
| Enumeration Date | 2007-04-16 |
| Last Update Date | 2014-12-17 |