| NPI | 1427426253 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: NY 090959) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) |
| 104100000X Social Worker (Licence: NY 099048-1) | |
| Enumeration Date | 2015-09-10 |
| Last Update Date | 2022-06-23 |