| NPI | 1770046658 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NY 35587) |
| Additional Taxonomies | 101YP1600X Counselor, Pastoral (Licence: NY EXEMPT) |
| 171M00000X Case Manager/Care Coordinator | |
| 172V00000X Community Health Worker (Licence: NY 3476) | |
| 175T00000X Peer Specialist (Licence: NY 3476) | |
| Enumeration Date | 2019-04-09 |
| Last Update Date | 2024-02-08 |