| NPI | 1730560277 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: NJ 37CA00125700) |
| Additional Taxonomies | 261QR0405X Clinic/Center Rehabilitation, Substance Use Disorder (Licence: NJ 37CA00125700) |
| Enumeration Date | 2015-06-10 |
| Last Update Date | 2023-01-10 |