| NPI | 1346964335 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NJ 37LC00364100) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NJ 44SL06817800) |
| Enumeration Date | 2022-10-03 |
| Last Update Date | 2024-02-18 |