| NPI | 1831107382 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: CT 13601) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: ME LC702) |
| Enumeration Date | 2006-08-03 |
| Last Update Date | 2024-01-16 |