| NPI | 1508429747 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: ME LC19773) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: ME MC17869) |
| Enumeration Date | 2019-04-14 |
| Last Update Date | 2023-10-12 |