| NPI | 1699275511 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: ME LC18143) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MC16784) |
| Enumeration Date | 2018-02-16 |
| Last Update Date | 2019-08-19 |