| NPI | 1639628951 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: ME LC22821) |
| Additional Taxonomies | 101Y00000X Counselor |
| 1041C0700X Social Worker, Clinical (Licence: FL SW16059) | |
| Enumeration Date | 2016-09-28 |
| Last Update Date | 2025-02-21 |