| NPI | 1891341624 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NY 114876) |
| Enumeration Date | 2019-08-16 |
| Last Update Date | 2023-03-10 |