| NPI | 1326029489 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NY 11769) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NY 055937) |
| Enumeration Date | 2005-11-07 |
| Last Update Date | 2007-07-08 |