| NPI | 1225617772 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: NY 112056) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NY 30762) |
| 1041S0200X Social Worker, School (Licence: NY 112056) | |
| Enumeration Date | 2021-04-02 |
| Last Update Date | 2023-10-05 |