| NPI | 1609825900 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: OR L5252) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: ME LC8315) |
| Enumeration Date | 2006-05-06 |
| Last Update Date | 2023-10-02 |