| NPI | 1609300367 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NY 30648) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NY 114451) |
| Enumeration Date | 2017-04-19 |
| Last Update Date | 2021-10-23 |