NPI | 1427694876 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 090247) |
Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NY 38855) |
101YM0800X Counselor, Mental Health | |
Enumeration Date | 2019-11-20 |
Last Update Date | 2024-09-13 |