| NPI | 1811223100 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 043858) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NY 5883) |
| 1041C0700X Social Worker, Clinical (Licence: CT 13451) | |
| Enumeration Date | 2009-10-21 |
| Last Update Date | 2023-10-16 |