| NPI | 1386894848 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 055629) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NY 10894 CASAC) |
| Enumeration Date | 2008-09-22 |
| Last Update Date | 2013-04-10 |