| NPI | 1003103052 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NJ 37PC00950300) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NY 006588) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NY 30537) | |
| Enumeration Date | 2011-06-28 |
| Last Update Date | 2024-11-06 |