| NPI | 1164473930 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: ME LC1445) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CCS3152) |
| 1041C0700X Social Worker, Clinical (Licence: ME LC1241) | |
| Enumeration Date | 2006-05-15 |
| Last Update Date | 2007-07-08 |