| NPI | 1194369819 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: NY 086277) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: NY 25793) |
| Enumeration Date | 2019-11-06 |
| Last Update Date | 2020-12-14 |