| NPI | 1346851698 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NJ 44SC06235100) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NJ 2018-000688) |
| 104100000X Social Worker (Licence: NJ SW-GTL-20-01154) | |
| Enumeration Date | 2020-08-11 |
| Last Update Date | 2023-06-23 |