| NPI | 1649820069 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NJ 44SC06121200) |
| Additional Taxonomies | 101Y00000X Counselor |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) | |
| 101YM0800X Counselor, Mental Health | |
| 104100000X Social Worker (Licence: NJ 44SL06466900) | |
| Enumeration Date | 2019-09-17 |
| Last Update Date | 2023-03-07 |