| NPI | 1710519970 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QA0401X Family Medicine, Addiction Medicine (Licence: NJ 25mb09077400) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| 101YM0800X Counselor, Mental Health | |
| 106H00000X Marriage & Family Therapist | |
| 133N00000X Nutritionist | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NJ 26no10537200) | |
| Enumeration Date | 2020-02-06 |
| Last Update Date | 2020-02-06 |