| NPI | 1972125326 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: NY 5322) |
| Additional Taxonomies | 175T00000X Peer Specialist (Licence: NY 4535) |
| Enumeration Date | 2020-05-08 |
| Last Update Date | 2022-02-16 |