| NPI | 1356021497 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NY 36365) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 36365) |
| Enumeration Date | 2023-07-24 |
| Last Update Date | 2023-07-24 |