| NPI | 1023207438 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: ME LC4848) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: ME CAC4049) |
| 101Y00000X Counselor | |
| Enumeration Date | 2007-10-22 |
| Last Update Date | 2019-07-23 |