| NPI | 1922525757 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 092374) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NY 33672) |
| 104100000X Social Worker (Licence: NY 100967) | |
| Enumeration Date | 2017-08-23 |
| Last Update Date | 2023-01-27 |