| NPI | 1124318811 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NJ 37LC00130200) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: PA PC005579) |
| 101YP2500X Counselor, Professional (Licence: PA PC005579) | |
| Enumeration Date | 2011-04-14 |
| Last Update Date | 2019-07-25 |