| NPI | 1548674435 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: ME CC4603) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: ME LC5584) |
| Enumeration Date | 2014-06-18 |
| Last Update Date | 2019-02-15 |