| NPI | 1982742714 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: VT 089-0000658) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: VT 000372) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: VT 103704) | |
| Enumeration Date | 2007-02-02 |
| Last Update Date | 2018-11-30 |