| NPI | 1972693182 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NY 0032911) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NY 0032911) |
| 103TF0200X Psychologist, Forensic (Licence: NY 0032911) | |
| Enumeration Date | 2006-10-16 |
| Last Update Date | 2007-07-08 |