| NPI | 1871982090 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: ME LC16584) |
| Additional Taxonomies | 104100000X Social Worker (Licence: ME LM14758) |
| Enumeration Date | 2015-01-12 |
| Last Update Date | 2023-01-11 |