| NPI | 1134468754 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NJ 37CA00106300) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical |
| 175T00000X Peer Specialist | |
| Enumeration Date | 2013-02-01 |
| Last Update Date | 2024-05-28 |