| NPI | 1396843710 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY R0-29790-1) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NY 5993) |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2014-08-01 |