| NPI | 1508851528 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: ME LC11034) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: FL 16760) |
| Enumeration Date | 2005-09-15 |
| Last Update Date | 2023-02-23 |