| NPI | 1003992512 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: NJ F18736) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NJ 37LC00011300) |
| 104100000X Social Worker (Licence: NJ 44SW00619000) | |
| Enumeration Date | 2006-10-27 |
| Last Update Date | 2007-07-09 |