| NPI | 1205187176 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NJ 37AC00063800) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NJ 37AC0006300) |
| 101YP1600X Counselor, Pastoral (Licence: NJ 37AC00063800) | |
| Enumeration Date | 2012-10-01 |
| Last Update Date | 2012-10-01 |