| NPI | 1952782369 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: ME CC5131) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: ME CAC5747) |
| Enumeration Date | 2015-06-11 |
| Last Update Date | 2022-11-10 |