| NPI | 1376879585 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: VT 068.0057145) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: VT 151.0127850) |
| Enumeration Date | 2009-10-22 |
| Last Update Date | 2024-02-14 |