| NPI | 1558530659 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: NJ 37PC00320100) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: NJ LC00144500) |
| Enumeration Date | 2008-02-22 |
| Last Update Date | 2008-02-22 |