| NPI | 1114434446 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 175T00000X Peer Specialist (Licence: NY NYCPS2287) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: NY 37119) |
| Enumeration Date | 2018-01-09 |
| Last Update Date | 2022-05-12 |