| NPI | 1194039602 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: VT 100.0045570) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: VT ASAC) |
| Enumeration Date | 2010-07-27 |
| Last Update Date | 2011-01-13 |