| NPI | 1558979005 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: NJ SW-GTL-20-01182) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NJ 37LC00361900) |
| 1041C0700X Social Worker, Clinical (Licence: NJ 44SC06132500) | |
| Enumeration Date | 2020-07-21 |
| Last Update Date | 2023-01-06 |