| NPI | 1588131247 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Additional Taxonomies | 224Z00000X Occupational Therapy Assistant (Licence: ME OA3591) |
| Enumeration Date | 2018-10-30 |
| Last Update Date | 2025-03-04 |