| NPI | 1154691459 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: ME CC4266) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: ME LC5211) |
| Enumeration Date | 2012-01-04 |
| Last Update Date | 2020-01-07 |