| NPI | 1750498648 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: ME LC19474) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: VT 0890000910) |
| Enumeration Date | 2006-08-24 |
| Last Update Date | 2020-11-20 |