| NPI | 1154691459 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: ME LC5211) |
| 101YP2500X Counselor, Professional (Licence: ME CC4266) | |
| Enumeration Date | 2012-01-04 |
| Last Update Date | 2025-01-07 |