| NPI | 1518235175 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NY 088250) |
| Enumeration Date | 2011-12-09 |
| Last Update Date | 2014-04-03 |