| NPI | 1427348762 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NJ 44SC05778300) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NH 44SL05636300) |
| Enumeration Date | 2011-04-07 |
| Last Update Date | 2023-08-25 |