| NPI | 1598322489 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: NY 096344) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NY 28281) |
| 1041S0200X Social Worker, School | |
| Enumeration Date | 2019-05-25 |
| Last Update Date | 2019-05-26 |