| NPI | 1881730901 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: ME LC2255) |
| Enumeration Date | 2007-01-29 |
| Last Update Date | 2021-02-02 |