| NPI | 1275904401 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: ME CC1518) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: ME CC1518) |
| Enumeration Date | 2015-10-14 |
| Last Update Date | 2019-07-02 |