| NPI | 1235387002 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163WA0400X Registered Nurse, Addiction (Substance Use Disorder) (Licence: NY 648364) |
| Additional Taxonomies | 101Y00000X Counselor |
| Enumeration Date | 2008-09-04 |
| Last Update Date | 2012-09-06 |