| NPI | 1659478741 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NJ 35S100180800) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NJ 35S100180800) |
| 103TC1900X Psychologist, Counseling (Licence: NJ 35S100180800) | |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2020-04-07 |