NPI | 1184158685 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NY 18-P011042-02) |
Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NY 31284) |
Enumeration Date | 2017-04-12 |
Last Update Date | 2024-07-30 |