| NPI | 1568531853 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: ME LC6588) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: ME LC6588) |
| 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: ME LC3737) | |
| Enumeration Date | 2006-11-08 |
| Last Update Date | 2012-12-21 |