| NPI | 1356802219 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CT 10542) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CT 1323) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NJ 37LC00269300) | |
| 1041C0700X Social Worker, Clinical (Licence: NJ 44SC05819000) | |
| Enumeration Date | 2019-03-25 |
| Last Update Date | 2023-01-16 |