| NPI | 1740831254 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NY 34951) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: NY 3360) |
| 175T00000X Peer Specialist (Licence: NY 3360) | |
| Enumeration Date | 2019-09-25 |
| Last Update Date | 2021-11-19 |