| NPI | 1770728255 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: FL SW 276) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: ME LC11456) |
| Enumeration Date | 2008-12-11 |
| Last Update Date | 2008-12-11 |