| NPI | 1124508205 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: DE PC-0011232) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NJ 37LC00208800) |
| Enumeration Date | 2018-08-17 |
| Last Update Date | 2022-07-02 |