| NPI | 1548010515 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 175T00000X Peer Specialist (Licence: NY CRPA-5954) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NY 38948) |
| 175T00000X Peer Specialist (Licence: NY NYCPS-P-5843) | |
| 175T00000X Peer Specialist (Licence: NY VSR-5013) | |
| Enumeration Date | 2024-03-25 |
| Last Update Date | 2024-03-25 |