| NPI | 1699257782 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: ME LC21511) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: ME MC17390) |
| Enumeration Date | 2018-09-05 |
| Last Update Date | 2023-12-04 |