| NPI | 1053857318 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: NY 090580) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NY 32482) |
| 1041C0700X Social Worker, Clinical (Licence: NY 090580) | |
| Enumeration Date | 2017-01-11 |
| Last Update Date | 2023-08-29 |