| NPI | 1760729545 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NJ 37LC00077700) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NJ 44SW04739900) |
| Enumeration Date | 2013-01-13 |
| Last Update Date | 2021-09-03 |