| NPI | 1376495283 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 175T00000X Peer Specialist (Licence: NJ 50062) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NJ 44SL06594700) |
| 106H00000X Marriage & Family Therapist (Licence: NJ 000109) | |
| Enumeration Date | 2026-02-12 |
| Last Update Date | 2026-02-12 |