| NPI | 1902279821 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: ME LC18009) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: ME CCS8285) |
| Enumeration Date | 2015-11-02 |
| Last Update Date | 2026-02-22 |