| NPI | 1992924005 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: NY 00059022) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NY 00059022) |
| 101YM0800X Counselor, Mental Health (Licence: NY 00059022) | |
| Enumeration Date | 2007-04-25 |
| Last Update Date | 2007-07-09 |