| NPI | 1073788246 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: NJ 44SC00753400) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: NJ 37FI00130900) |
| 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: NJ 37LC00027100) | |
| 1041C0700X Social Worker Clinical (Licence: NY R 039990-1) | |
| 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: NY 4161) | |
| Enumeration Date | 2008-04-28 |
| Last Update Date | 2015-09-13 |