| NPI | 1487334710 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: ME LC25838) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CO CSW.09932002) |
| 104100000X Social Worker | |
| Enumeration Date | 2023-07-21 |
| Last Update Date | 2026-07-10 |