| NPI | 1972744423 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NY 050485) |
| Enumeration Date | 2009-03-12 |
| Last Update Date | 2020-06-07 |