| NPI | 1184689176 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: ME LC11050) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: ME LC2593) |
| 1041C0700X Social Worker, Clinical (Licence: CO CSW09924354) | |
| Enumeration Date | 2006-04-20 |
| Last Update Date | 2020-01-08 |