NPI | 1306598404 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: NJ 37PC00749900) |
Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NJ 37LC00342100) |
Enumeration Date | 2022-01-20 |
Last Update Date | 2022-01-20 |