| NPI | 1649401977 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NJ 37LC00201300) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| 1041C0700X Social Worker, Clinical (Licence: NJ 44SL05915100) | |
| Enumeration Date | 2009-08-04 |
| Last Update Date | 2016-05-19 |