| NPI | 1629133723 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: NY 11561) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: NJ 37LC00046400) |
| 1041C0700X Social Worker Clinical (Licence: NY 071143-1) | |
| 1041C0700X Social Worker Clinical (Licence: NJ 44SC05185100) | |
| Enumeration Date | 2006-12-27 |
| Last Update Date | 2007-07-08 |