| NPI | 1093176844 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: ME CC5827) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: ME LC6923) |
| 101YM0800X Counselor, Mental Health (Licence: ME XL4930) | |
| Enumeration Date | 2016-03-08 |
| Last Update Date | 2021-03-25 |