| NPI | 1669996203 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: ME LC18242) |
| Additional Taxonomies | 104100000X Social Worker (Licence: ME MC16770) |
| Enumeration Date | 2017-07-26 |
| Last Update Date | 2021-11-12 |