| NPI | 1518384288 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NJ 37LC00222400) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NJ 44SC05730200) |
| Enumeration Date | 2014-03-19 |
| Last Update Date | 2017-07-18 |