| NPI | 1922640382 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 099299) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| 104100000X Social Worker (Licence: NY 113782) | |
| 1041S0200X Social Worker, School (Licence: NY 099299) | |
| Enumeration Date | 2019-10-16 |
| Last Update Date | 2025-03-13 |