| NPI | 1053528372 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 73 077897) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NY 12062) |
| 104100000X Social Worker (Licence: NY 075045-1) | |
| Enumeration Date | 2007-05-17 |
| Last Update Date | 2010-10-22 |