| NPI | 1386075505 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: NJ 37PC00212700) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: NJ 37LC00105700) |
| Enumeration Date | 2013-12-13 |
| Last Update Date | 2013-12-13 |