| NPI | 1144985615 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: ME LSX20674) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: ME CAC7807) |
| Enumeration Date | 2021-11-01 |
| Last Update Date | 2021-11-01 |