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 |