| NPI | 1689877052 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NY 4957) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NY 000529) |
| 106H00000X Marriage & Family Therapist (Licence: NY 000250) | |
| Enumeration Date | 2007-06-06 |
| Last Update Date | 2007-07-08 |