| NPI | 1518005461 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NY CASAC-8557) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: PA 5710) |
| 101YP2500X Counselor, Professional (Licence: PA PC004427) | |
| Enumeration Date | 2007-02-02 |
| Last Update Date | 2016-05-27 |