NPI | 1760560080 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: NJ 37PC00173600) |
Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NJ 37LC00082800) |
Enumeration Date | 2006-11-02 |
Last Update Date | 2024-11-08 |