| NPI | 1619056579 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: VT 000218) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: VT 000391) |
| Enumeration Date | 2006-11-03 |
| Last Update Date | 2007-07-09 |