| NPI | 1821455171 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: ME LC17107) |
| Additional Taxonomies | 104100000X Social Worker (Licence: ME MC15585) |
| Enumeration Date | 2016-01-18 |
| Last Update Date | 2019-02-13 |