| NPI | 1184868515 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NY 3255) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NY 500969) | |
| Enumeration Date | 2009-04-29 |
| Last Update Date | 2012-06-29 |