| NPI | 1942469648 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: FL SW17601) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: ME LC5946) |
| Enumeration Date | 2008-06-06 |
| Last Update Date | 2023-11-03 |