| NPI | 1013217546 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: VT 089.0090488) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: VT 151.0126712) |
| Enumeration Date | 2010-11-01 |
| Last Update Date | 2018-03-17 |