| NPI | 1134377708 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: ME LC4926) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: ME LC2773) |
| Enumeration Date | 2008-09-08 |
| Last Update Date | 2010-03-17 |