NPI | 1811534670 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NY 38384) |
Additional Taxonomies | 175T00000X Peer Specialist (Licence: NY 2610) |
Enumeration Date | 2019-11-28 |
Last Update Date | 2023-04-21 |