| NPI | 1215249602 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: NY P80372) |
| Enumeration Date | 2010-07-14 |
| Last Update Date | 2012-02-08 |