| NPI | 1437846268 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Additional Taxonomies | 175T00000X Peer Specialist (Licence: NY NYCPS-P-5394) |
| Enumeration Date | 2023-04-21 |
| Last Update Date | 2024-10-02 |