| NPI | 1093883365 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: VT 089-0000306) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: VT 000094) |
| Enumeration Date | 2006-12-02 |
| Last Update Date | 2013-09-17 |