| NPI | 1720329576 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NJ 44SC05605500) |
| Additional Taxonomies | 103TA0400X Psychologist, Addiction (Substance Use Disorder) (Licence: NJ 37LC0021100) |
| Enumeration Date | 2013-03-04 |
| Last Update Date | 2016-06-16 |