| NPI | 1780745174 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NJ 44SC01029400) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: NJ 44SC01029400) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NJ 44SC01029400) | |
| 101YP2500X Counselor, Professional (Licence: NJ 44SC01029400) | |
| 101YS0200X Counselor, School (Licence: NJ 44SC01029400) | |
| Enumeration Date | 2006-12-12 |
| Last Update Date | 2011-12-14 |