| NPI | 1578955498 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NY 007216) |
| 101YM0800X Counselor, Mental Health | |
| Enumeration Date | 2015-03-02 |
| Last Update Date | 2025-02-13 |