| NPI | 1568908010 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: ME LC17760) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: ME MC16410) |
| Enumeration Date | 2017-01-09 |
| Last Update Date | 2022-02-17 |