| NPI | 1407250988 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: NY 300248) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NY 28052) |
| 101YM0800X Counselor, Mental Health (Licence: NY 005333-1) | |
| Enumeration Date | 2014-10-13 |
| Last Update Date | 2024-08-20 |