| NPI | 1093059859 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: NJ 37AC00141100) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: NJ 37AC00141100) |
| 106H00000X Marriage & Family Therapist (Licence: NJ 37AC00141100) | |
| Enumeration Date | 2012-11-18 |
| Last Update Date | 2012-11-18 |