| NPI | 1184348278 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NJ 44SC06239500) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NJ 44SC06239500) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NJ 37LC00355100) | |
| Enumeration Date | 2022-10-03 |
| Last Update Date | 2023-11-14 |