| NPI | 1700895158 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: VT 068-0000207) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: VT 068-0000207) |
| 103T00000X Psychologist (Licence: VT 068-0000207) | |
| Enumeration Date | 2006-08-05 |
| Last Update Date | 2008-03-21 |