| NPI | 1932261088 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: ME LC4061) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: ME LS5898) |
| Enumeration Date | 2006-12-15 |
| Last Update Date | 2012-01-19 |