| NPI | 1538592787 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: ME LC15906) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: ME MC14337) |
| Enumeration Date | 2013-08-12 |
| Last Update Date | 2025-04-15 |