| NPI | 1891223541 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 093504) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NY 31568) |
| 104100000X Social Worker (Licence: NY 105434) | |
| Enumeration Date | 2017-05-25 |
| Last Update Date | 2023-06-21 |