| NPI | 1346476561 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: VT 068-0050720) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: VT 000521) |
| Enumeration Date | 2009-06-02 |
| Last Update Date | 2015-12-23 |