| 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 |