| NPI | 1992101141 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NY 38640-T) |
| Additional Taxonomies | 104100000X Social Worker |
| Enumeration Date | 2014-11-17 |
| Last Update Date | 2024-08-21 |