| NPI | 1427068733 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: VT 068-0000302) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: VT 000202) |
| 101Y00000X Counselor (Licence: VT 0680000302) | |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: VT 000202) | |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: VT 0680000302) | |
| 101YM0800X Counselor, Mental Health (Licence: VT 000202) | |
| 103T00000X Psychologist (Licence: VT 000202) | |
| 103T00000X Psychologist (Licence: VT 068-0000302) | |
| Enumeration Date | 2006-08-09 |
| Last Update Date | 2015-10-02 |