| NPI | 1780497610 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: NJ 37AC00847300) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: NJ 37AC00847300) |
| 101YM0800X Counselor Mental Health (Licence: NJ 37AC00847300) | |
| Enumeration Date | 2025-01-27 |
| Last Update Date | 2025-01-29 |