| NPI | 1154157196 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: NJ 37AC00863300) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NJ 2024-000326) |
| Enumeration Date | 2024-09-09 |
| Last Update Date | 2025-04-09 |