| NPI | 1073669115 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: NJ 35SI0058560) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: PA PC005866) |
| 101YM0800X Counselor Mental Health (Licence: PA PC005866) | |
| 101YP2500X Counselor Professional (Licence: PA PC005866) | |
| Enumeration Date | 2007-01-25 |
| Last Update Date | 2018-03-21 |