| NPI | 1538399597 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 081465R) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NY 17162) |
| 104100000X Social Worker (Licence: NY 067040-1) | |
| Enumeration Date | 2009-07-23 |
| Last Update Date | 2014-04-04 |