| NPI | 1538740071 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NY 7203) |
| Additional Taxonomies | 282N00000X General Acute Care Hospital |
| Enumeration Date | 2021-04-16 |
| Last Update Date | 2021-04-20 |