| NPI | 1104468222 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NJ 37LC00298500) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NJ 37AC00464100) |
| Enumeration Date | 2019-10-09 |
| Last Update Date | 2019-10-09 |