| NPI | 1528454998 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 086843) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NY 18773) |
| 104100000X Social Worker (Licence: NY 092557) | |
| 405300000X Prevention Professional (Licence: NY 2138) | |
| Enumeration Date | 2015-04-12 |
| Last Update Date | 2018-05-08 |