| NPI | 1023316494 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: VT 0680101473) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: VT 000526) |
| Enumeration Date | 2011-03-08 |
| Last Update Date | 2014-09-05 |