| NPI | 1760255251 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NY 121266-01) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NY 121266-01) |
| Enumeration Date | 2023-11-06 |
| Last Update Date | 2024-08-20 |