| NPI | 1811551252 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 194629) |
| Enumeration Date | 2019-04-30 |
| Last Update Date | 2024-03-13 |