| NPI | 1174806442 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: NY 083303) |
| Additional Taxonomies | 101Y00000X Counselor |
| 101YM0800X Counselor, Mental Health | |
| 103TA0400X Psychologist, Addiction (Substance Use Disorder) (Licence: NY 083303) | |
| 103TC1900X Psychologist, Counseling (Licence: NY 083303) | |
| 1041C0700X Social Worker, Clinical (Licence: NY 086100) | |
| Enumeration Date | 2011-09-23 |
| Last Update Date | 2021-07-08 |