| NPI | 1629130497 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: ME LC18024) |
| Additional Taxonomies | 104100000X Social Worker (Licence: ME LS7242) |
| 1041C0700X Social Worker, Clinical (Licence: ME MC16579) | |
| Enumeration Date | 2006-12-15 |
| Last Update Date | 2019-07-18 |