| NPI | 1649684432 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: ME LC13386) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NY R059231-1) |
| Enumeration Date | 2014-06-19 |
| Last Update Date | 2014-06-19 |