| NPI | 1780089961 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: VT 068.0094119) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: VT 0000627) |
| 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: VT 000627) | |
| Enumeration Date | 2014-10-30 |
| Last Update Date | 2015-10-05 |