| NPI | 1912426594 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NY 10181) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 405300000X Prevention Professional (Licence: NY 706) | |
| Enumeration Date | 2017-09-14 |
| Last Update Date | 2017-09-21 |