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 |