| NPI | 1336187954 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: VT 0680000564) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: VT 151.0127838) |
| Enumeration Date | 2006-06-04 |
| Last Update Date | 2022-06-08 |