| NPI | 1073822946 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 083553) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: VT 0890054418) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: VT 000534) | |
| Enumeration Date | 2010-09-27 |
| Last Update Date | 2015-10-05 |