| NPI | 1932255114 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: VT 089-0000595) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: VT 151-0127250) |
| Enumeration Date | 2007-01-28 |
| Last Update Date | 2019-08-20 |