| NPI | 1700921889 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NY 008985) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| 103T00000X Psychologist (Licence: NY 00895) | |
| 103T00000X Psychologist (Licence: NY 008985) | |
| Enumeration Date | 2007-02-20 |
| Last Update Date | 2025-09-11 |