| NPI | 1043453483 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: ME XL4096) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: ME LC4070) |
| Enumeration Date | 2009-04-15 |
| Last Update Date | 2013-07-29 |