| NPI | 1477891745 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: NJ 37PC00464900) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NJ 37CA00033700) |
| 101YM0800X Counselor, Mental Health (Licence: NJ S4065) | |
| Enumeration Date | 2013-01-22 |
| Last Update Date | 2013-01-22 |