| NPI | 1023378627 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: VT 068.0106606) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: VT 104514) |
| Enumeration Date | 2012-05-17 |
| Last Update Date | 2015-07-31 |