| NPI | 1760566814 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: ME LC15956) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: ME CAC7107) |
| 1041C0700X Social Worker Clinical (Licence: MA 113620) | |
| Enumeration Date | 2006-10-25 |
| Last Update Date | 2022-08-19 |