| NPI | 1811287592 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NY 005386) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NY 22047) |
| 101YP2500X Counselor, Professional (Licence: NY 669294) | |
| Enumeration Date | 2011-04-14 |
| Last Update Date | 2015-10-01 |