| NPI | 1518292200 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: ME CC2708) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: ME LC3002) |
| 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: ME LC3002) | |
| Enumeration Date | 2009-10-14 |
| Last Update Date | 2013-10-31 |