NPI | 1154552552 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: ME CC3560) |
Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: ME LC4379) |
Enumeration Date | 2009-08-03 |
Last Update Date | 2021-08-03 |