| NPI | 1386846285 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NJ 37LC00127000) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: NJ PC00683) |
| 103TS0200X Psychologist, School (Licence: NJ 00042019) | |
| 104100000X Social Worker (Licence: NJ SW00522) | |
| Enumeration Date | 2007-06-03 |
| Last Update Date | 2007-07-08 |