NPI | 1427379973 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: ME MC10214) |
Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: ME LC3439) |
Enumeration Date | 2010-06-18 |
Last Update Date | 2010-06-18 |