| NPI | 1285789180 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 079001) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NY 17573) |
| 1041C0700X Social Worker, Clinical (Licence: NY 067008-1) | |
| Enumeration Date | 2007-01-24 |
| Last Update Date | 2013-12-31 |