| NPI | 1366697021 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: ME LC14790) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: ME LC4173) |
| Enumeration Date | 2008-11-22 |
| Last Update Date | 2015-01-20 |