| NPI | 1124486477 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NJ 37LC00197500) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NJ 37LC00197500) |
| 101YP2500X Counselor, Professional (Licence: NJ 37LC00197500) | |
| 106H00000X Marriage & Family Therapist (Licence: NJ 37LC00197500) | |
| Enumeration Date | 2016-02-02 |
| Last Update Date | 2016-02-02 |