| NPI | 1568475721 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: ME LC10563) |
| Additional Taxonomies | 104100000X Social Worker (Licence: ME MC6907) |
| Enumeration Date | 2006-08-15 |
| Last Update Date | 2009-05-19 |