| NPI | 1942747571 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: ME LC18019) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: ME LC6685) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: ME CCS7578) | |
| Enumeration Date | 2017-01-20 |
| Last Update Date | 2024-08-13 |