| NPI | 1477036838 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: ME LC20099) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical |
| Enumeration Date | 2018-09-12 |
| Last Update Date | 2022-01-11 |