| NPI | 1548786288 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NY 29895) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NY 099587) |
| Enumeration Date | 2017-08-15 |
| Last Update Date | 2022-07-21 |