| NPI | 1326531971 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: ME LC21635) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: ME LC7021) |
| Enumeration Date | 2018-06-08 |
| Last Update Date | 2026-03-24 |