| NPI | 1184082539 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NJ 44SC05631600) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NJ 37LC00231100) |
| 1041C0700X Social Worker, Clinical (Licence: PA CW019763) | |
| Enumeration Date | 2016-01-31 |
| Last Update Date | 2020-12-17 |