| NPI | 1366494072 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NJ 37LC00057400) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NJ 37PC00047500) |
| 1041C0700X Social Worker, Clinical (Licence: NJ 44SC05174000) | |
| 106H00000X Marriage & Family Therapist (Licence: NJ 37F100160300) | |
| Enumeration Date | 2006-05-17 |
| Last Update Date | 2009-05-01 |