| NPI | 1689111205 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NY 007590) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NY 34944) |
| 101YP2500X Counselor, Professional (Licence: NJ 37PC00957800) | |
| Enumeration Date | 2017-01-20 |
| Last Update Date | 2023-06-09 |