| NPI | 1467876987 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NY 008512) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NY 31607) |
| 101YP2500X Counselor, Professional (Licence: NJ 37PC01096700) | |
| Enumeration Date | 2014-02-05 |
| Last Update Date | 2025-11-25 |