| NPI | 1841493269 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: NY 253) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NY 11582) |
| Enumeration Date | 2007-06-06 |
| Last Update Date | 2007-07-08 |