| NPI | 1508607797 |
|---|---|
| Former Name | THOMAS RUSSELL BRASWELL |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NJ 2023-000013) |
| Enumeration Date | 2024-06-03 |
| Last Update Date | 2024-06-03 |