| NPI | 1053696054 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: NY 112312-01) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NY 10278) |
| Enumeration Date | 2011-10-21 |
| Last Update Date | 2024-08-01 |