| NPI | 1982079794 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: ME LC19829) |
| Additional Taxonomies | 104100000X Social Worker (Licence: ME MC15650) |
| Enumeration Date | 2015-12-04 |
| Last Update Date | 2022-11-02 |