| NPI | 1780969949 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163WP0808X Registered Nurse Psychiatric/Mental Health (Licence: NY 604401) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: NY 604401) |
| 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: NY 24330) | |
| Enumeration Date | 2011-10-19 |
| Last Update Date | 2020-01-28 |