| NPI | 1578083408 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: AZ LCSW-21870) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NJ LCSW-44SC05894800) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NJ LCADC-37LC00317800) | |
| Enumeration Date | 2017-06-21 |
| Last Update Date | 2024-11-13 |