| NPI | 1548690621 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NJ 37LC00199200) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NJ 44SL05739500) |
| Enumeration Date | 2013-11-26 |
| Last Update Date | 2013-11-26 |