| NPI | 1487182358 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NJ 37LC00288400) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: NJ 37PC00899700) |
| Enumeration Date | 2017-05-23 |
| Last Update Date | 2024-05-06 |