| NPI | 1396479655 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NJ 37CA00187500) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| 171M00000X Case Manager/Care Coordinator (Licence: NJ 37CA00187500) | |
| Enumeration Date | 2022-07-13 |
| Last Update Date | 2024-04-24 |