| NPI | 1497127930 |
|---|---|
| Former Name | GREGORY ROACH |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NY NYP-006203-2014) |
| Enumeration Date | 2015-10-23 |
| Last Update Date | 2015-10-23 |