| NPI | 1184263659 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: ME LC7733) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NC P013480) |
| Enumeration Date | 2020-01-02 |
| Last Update Date | 2021-07-08 |