| NPI | 1659412526 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: ME LC3924) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: ME LADC #3924) |
| Enumeration Date | 2007-02-12 |
| Last Update Date | 2021-02-02 |