| NPI | 1710266036 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 089823) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NY 19876) |
| 104100000X Social Worker (Licence: NY 076411) | |
| Enumeration Date | 2011-08-04 |
| Last Update Date | 2020-10-06 |