| NPI | 1790878700 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: ME LC1397) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: ME CCS4523) |
| 101YM0800X Counselor Mental Health (Licence: ME CC1372) | |
| Enumeration Date | 2006-10-02 |
| Last Update Date | 2010-03-08 |