| NPI | 1568727394 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NJ 37LC00262700) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NJ 44SL06329500) |
| Enumeration Date | 2012-07-09 |
| Last Update Date | 2025-01-28 |