| NPI | 1689283822 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator (Licence: NJ 44SC06308600) |
| Enumeration Date | 2020-07-23 |
| Last Update Date | 2024-04-24 |