| NPI | 1144772666 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: NJ 44SL06177600) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: NJ 44SL06177600) |
| 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: NJ 37LC00246000) | |
| 101YM0800X Counselor Mental Health (Licence: 44SL06177600) | |
| 106H00000X Marriage & Family Therapist (Licence: 44SL06177600) | |
| Enumeration Date | 2016-11-01 |
| Last Update Date | 2021-07-27 |