| NPI | 1023654431 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NY 35038) |
| Additional Taxonomies | 175T00000X Peer Specialist (Licence: NY CRPA-2229) |
| Enumeration Date | 2019-11-20 |
| Last Update Date | 2020-12-14 |