| NPI | 1639436744 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: ME LC14615) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical |
| 1041C0700X Social Worker, Clinical (Licence: ME MC13008) | |
| Enumeration Date | 2012-04-13 |
| Last Update Date | 2021-08-03 |