| NPI | 1235360330 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: ME LC3827) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: ME CCS4213) |
| 101YM0800X Counselor, Mental Health (Licence: ME LC12059) | |
| Enumeration Date | 2009-08-06 |
| Last Update Date | 2009-08-06 |