| NPI | 1548769854 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: ME LC20106) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MA 116296) |
| Enumeration Date | 2018-02-02 |
| Last Update Date | 2021-08-04 |