| NPI | 1689839474 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NY 078694) |
| Enumeration Date | 2008-07-22 |
| Last Update Date | 2021-02-15 |