| NPI | 1912946179 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: ME LC3357) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: ME LC6496) |
| Enumeration Date | 2006-06-05 |
| Last Update Date | 2007-07-09 |