| NPI | 1831667302 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: ME LC19348) |
| Additional Taxonomies | 104100000X Social Worker (Licence: ME MC17615) |
| Enumeration Date | 2018-11-02 |
| Last Update Date | 2023-02-14 |