| NPI | 1699796102 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: VT 0470000388) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: VT 047-0000388) |
| 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: VT 000232) | |
| 103TA0400X Psychologist Addiction (Substance Use Disorder) (Licence: VT 000232) | |
| Enumeration Date | 2006-07-21 |
| Last Update Date | 2008-03-21 |