| NPI | 1871256172 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225C00000X Rehabilitation Counselor (Licence: 00356065) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: NY 36561) |
| Enumeration Date | 2021-10-14 |
| Last Update Date | 2021-10-14 |