| NPI | 1598872491 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: ME LC5201) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: ME CC3961) |
| Enumeration Date | 2006-08-24 |
| Last Update Date | 2016-10-25 |