NPI | 1053479915 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: ME LC3744) |
Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: ME LC901) |
101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: ME CCS3537) | |
Enumeration Date | 2006-12-04 |
Last Update Date | 2016-02-02 |