| NPI | 1316167836 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NY R050001-1) |
| Additional Taxonomies | 102L00000X Psychoanalyst (Licence: NY R050001-1) |
| 1041C0700X Social Worker, Clinical (Licence: NY R050001-1) | |
| Enumeration Date | 2007-04-26 |
| Last Update Date | 2007-07-08 |