| NPI | 1083852735 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NY 13105) |
| Additional Taxonomies | 283Q00000X Psychiatric Hospital (Licence: NY 13105) |
| Enumeration Date | 2009-02-02 |
| Last Update Date | 2009-02-02 |