| NPI | 1568868586 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: ME CC4423) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: ME LC5922) |
| Enumeration Date | 2014-11-19 |
| Last Update Date | 2018-10-20 |