| NPI | 1821145525 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: ME LC11460) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: ME MC8738) |
| Enumeration Date | 2007-01-04 |
| Last Update Date | 2011-12-02 |