| NPI | 1710277306 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MA 1025122) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: ME LC12948) |
| Enumeration Date | 2011-04-15 |
| Last Update Date | 2018-12-20 |