| NPI | 1114458700 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: NJ 37PC00501300) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: NJ 37LC00228500) |
| Enumeration Date | 2017-03-24 |
| Last Update Date | 2022-05-13 |