NPI | 1013030972 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NY 067599) |
Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NY 13192) |
1041C0700X Social Worker, Clinical (Licence: NY 082493) | |
Enumeration Date | 2007-04-07 |
Last Update Date | 2019-08-31 |