NPI | 1235788555 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NJ 44SC05740700) |
Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NJ 37LC00270000) |
Enumeration Date | 2019-09-09 |
Last Update Date | 2019-09-09 |