| NPI | 1417445024 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: ME LC19449) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: ME CAC6566) |
| Enumeration Date | 2018-04-30 |
| Last Update Date | 2021-02-02 |