| NPI | 1396505764 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NY 37461) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: NY P132566) |
| Enumeration Date | 2024-03-21 |
| Last Update Date | 2025-04-15 |