| 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 |