| NPI | 1053439950 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: VT 000169) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: VT 000169) |
| Enumeration Date | 2007-03-27 |
| Last Update Date | 2007-07-10 |