| NPI | 1346488731 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: ME ME512754) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: ME ME511784) |
| Enumeration Date | 2009-01-23 |
| Last Update Date | 2009-01-23 |