| NPI | 1467746982 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: NJ 37PC00034000) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NJ 37LC00072800) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NY 4331) | |
| 101YM0800X Counselor, Mental Health (Licence: NY 999-1) | |
| Enumeration Date | 2011-06-01 |
| Last Update Date | 2011-06-01 |