| NPI | 1619646569 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NY 100934) |
| Enumeration Date | 2021-09-13 |
| Last Update Date | 2025-09-12 |