| NPI | 1255577714 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: VT 000447) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: VT 000447) |
| 171M00000X Case Manager/Care Coordinator | |
| Enumeration Date | 2009-01-05 |
| Last Update Date | 2019-05-30 |