| NPI | 1619228582 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NY 25740) |
| Additional Taxonomies | 172V00000X Community Health Worker (Licence: NY 25740) |
| Enumeration Date | 2012-10-02 |
| Last Update Date | 2022-08-17 |