| NPI | 1790794139 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: VT 000179) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: VT 000179) |
| 101YM0800X Counselor, Mental Health (Licence: VT 000179) | |
| Enumeration Date | 2006-08-05 |
| Last Update Date | 2008-03-21 |