| NPI | 1780646323 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NH 55) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: ME LC1269) |
| Enumeration Date | 2006-04-06 |
| Last Update Date | 2014-06-04 |