| NPI | 1619635851 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 102L00000X Psychoanalyst (Licence: NJ 44SC06042300) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NJ 37LC00323200) |
| Enumeration Date | 2021-12-06 |
| Last Update Date | 2021-12-06 |