| NPI | 1760762611 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: NY P80139) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NY P80139) |
| 104100000X Social Worker (Licence: NY P80139) | |
| Enumeration Date | 2011-08-24 |
| Last Update Date | 2013-03-13 |