| NPI | 1164318333 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NY 40038) |
| Additional Taxonomies | 146N00000X Emergency Medical Technician, Basic (Licence: NY 369013) |
| Enumeration Date | 2025-06-16 |
| Last Update Date | 2025-06-16 |