| NPI | 1295123222 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: ME LC18074) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: ME CCS5117) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: ME LC4633) | |
| Enumeration Date | 2014-12-29 |
| Last Update Date | 2022-03-31 |