| NPI | 1073275830 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: NJ 44SC06027600) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: NJ 37LC00341700) |
| Enumeration Date | 2021-10-08 |
| Last Update Date | 2022-06-26 |