| NPI | 1801033105 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 085923) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| 104100000X Social Worker (Licence: NY 081211-1) | |
| 101YM0800X Counselor, Mental Health | |
| Enumeration Date | 2009-01-08 |
| Last Update Date | 2023-04-10 |