| NPI | 1497766778 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: VT 042-0009733) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: VT 068-0045710) |
| Enumeration Date | 2006-08-11 |
| Last Update Date | 2016-04-05 |