| NPI | 1306016514 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: ME CC4152) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: ME CC4152) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: ME CAC5432) | |
| Enumeration Date | 2008-03-04 |
| Last Update Date | 2016-06-22 |