| NPI | 1346465911 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NJ 44sc04649800) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NJ 37LC00027400) |
| 106H00000X Marriage & Family Therapist (Licence: NJ 37FI00156200) | |
| Enumeration Date | 2007-04-17 |
| Last Update Date | 2014-10-24 |