| NPI | 1487828869 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: FL SW22350) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NY 078326) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NY 075485) | |
| Enumeration Date | 2008-04-17 |
| Last Update Date | 2026-06-02 |