| NPI | 1316113434 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: NY 106307) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NY 17044) |
| Enumeration Date | 2008-05-08 |
| Last Update Date | 2019-06-18 |