| NPI | 1881772358 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NY 9833) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NY 014138) |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2007-07-08 |