| NPI | 1821239856 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 079282) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NY 076319) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NY 23899) | |
| Enumeration Date | 2009-03-21 |
| Last Update Date | 2012-10-08 |