| NPI | 1932368511 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 077838-1) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NY 077838-1) |
| 101YM0800X Counselor, Mental Health (Licence: NY 077838-1) | |
| 1041C0700X Social Worker, Clinical (Licence: NY 077838) | |
| Enumeration Date | 2008-06-09 |
| Last Update Date | 2025-03-13 |