| NPI | 1982299897 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 095457-01) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NY 34488) |
| 1041S0200X Social Worker, School (Licence: NY 1265042181) | |
| Enumeration Date | 2021-03-02 |
| Last Update Date | 2023-08-30 |