| NPI | 1386914711 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NY 007883) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NY 32439) |
| 101YM0800X Counselor, Mental Health (Licence: MA 12800) | |
| 101YM0800X Counselor, Mental Health (Licence: CT 5432) | |
| Enumeration Date | 2012-01-02 |
| Last Update Date | 2022-12-29 |