| NPI | 1578833430 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NY 18 006457) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: CT 46.002435) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CT 44.001120) | |
| Enumeration Date | 2012-01-10 |
| Last Update Date | 2016-06-14 |