| NPI | 1952447179 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: ME LC12734) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: ME CCS4442) |
| 1041C0700X Social Worker, Clinical (Licence: ME LC3551) | |
| Enumeration Date | 2007-01-29 |
| Last Update Date | 2021-03-17 |