NPI | 1699400770 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: ME CAC7941) |
Additional Taxonomies | 106S00000X Behavior Technician (Licence: ME 36536) |
Enumeration Date | 2022-07-21 |
Last Update Date | 2022-07-21 |