| NPI | 1659862142 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: ME LC19139) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: MA 1021545) |
| 1041C0700X Social Worker Clinical (Licence: PA CW019613) | |
| Enumeration Date | 2018-05-21 |
| Last Update Date | 2022-08-31 |