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 |