| NPI | 1740223833 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 074294) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NY 12695) |
| 1041C0700X Social Worker, Clinical (Licence: VT 089-0109022) | |
| Enumeration Date | 2006-06-14 |
| Last Update Date | 2015-02-24 |