| NPI | 1942209739 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: ME CC3108) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: ME CAC3322) |
| Enumeration Date | 2005-07-14 |
| Last Update Date | 2025-09-23 |