| NPI | 1578780615 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: VT 000038) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: VT 068-0000369) |
| Enumeration Date | 2007-04-19 |
| Last Update Date | 2007-07-08 |