| NPI | 1144694894 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: ME LC1454) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: ME CCS3597) |
| 104100000X Social Worker (Licence: ME cc1511) | |
| Enumeration Date | 2015-11-18 |
| Last Update Date | 2015-11-18 |