| NPI | 1588116750 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: ME LC16772) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: CO CSW.09924223) |
| Enumeration Date | 2016-11-03 |
| Last Update Date | 2017-11-13 |