| NPI | 1780885707 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NJ 37lc00047400) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NJ 37pc00069600) |
| Enumeration Date | 2007-05-29 |
| Last Update Date | 2007-07-08 |