| NPI | 1407432156 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: NY 113305-01) |
| Additional Taxonomies | 101Y00000X Counselor |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NY 26460) | |
| Enumeration Date | 2021-03-23 |
| Last Update Date | 2022-09-29 |