| NPI | 1801166905 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CT 000962) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NY 084504) |
| Enumeration Date | 2012-01-05 |
| Last Update Date | 2014-01-16 |