NPI | 1093772345 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: VT 000264) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: VT 068-0000469) |
Enumeration Date | 2006-04-28 |
Last Update Date | 2007-07-08 |