| NPI | 1205826740 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: NJ FI001347) |
| Enumeration Date | 2005-10-26 |
| Last Update Date | 2007-07-08 |