| NPI | 1437575438 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: NY 10938) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: NY 000983) |
| Enumeration Date | 2014-03-14 |
| Last Update Date | 2014-03-14 |