| NPI | 1912277534 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: VT 068.0060333) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: VT 0005003) |
| Enumeration Date | 2012-01-12 |
| Last Update Date | 2014-09-17 |