| NPI | 1902815608 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: VT 151.0127032) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: VT 000385) |
| 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: VT 000385) | |
| 101YM0800X Counselor Mental Health (Licence: VT 000385) | |
| 101YP2500X Counselor Professional (Licence: VT 097.0072903) | |
| Enumeration Date | 2006-08-05 |
| Last Update Date | 2021-06-23 |