| NPI | 1891567137 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: ME LC24057) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: UT 12443784-3501) |
| Enumeration Date | 2023-10-30 |
| Last Update Date | 2025-01-26 |