| NPI | 1619349180 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: NY 099544) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NY 101764) |
| 101YA0400X Counselor Addiction (Substance Use Disorder) | |
| Enumeration Date | 2015-10-23 |
| Last Update Date | 2025-02-20 |