| NPI | 1134160310 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: VT 047.0000722) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: VT 151.0134181) |
| 101YM0800X Counselor, Mental Health | |
| Enumeration Date | 2006-06-09 |
| Last Update Date | 2023-12-20 |