| NPI | 1902301757 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: NY 099897) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NY CASAC-34038) |
| Enumeration Date | 2018-03-26 |
| Last Update Date | 2023-05-08 |