| NPI | 1548815806 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: NJ 37PC00887300) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NJ 37CA00141400) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NJ 37LC00323800) | |
| 101YM0800X Counselor, Mental Health (Licence: NJ 37AC00538000) | |
| Enumeration Date | 2019-08-05 |
| Last Update Date | 2023-01-31 |