| NPI | 1790102093 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: ME MC14888) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: ME LC 5014) |
| Enumeration Date | 2014-03-25 |
| Last Update Date | 2014-07-24 |