| NPI | 1942502349 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: VT 068.0115899) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: NH 884) |
| 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: VT 151.0124425) | |
| 101YM0800X Counselor Mental Health (Licence: NH 777) | |
| Enumeration Date | 2010-11-17 |
| Last Update Date | 2018-04-04 |