NPI | 1669537346 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: ME LC859) |
Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: ME CC532) |
Enumeration Date | 2006-12-24 |
Last Update Date | 2024-10-27 |