| NPI | 1972755981 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: ME LC1075) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: AZ RLCSW-15037) |
| Enumeration Date | 2008-10-21 |
| Last Update Date | 2011-03-30 |