| NPI | 1790180438 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: NJ 37PC00881700) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NJ 37LC00194600) |
| 101YM0800X Counselor, Mental Health (Licence: NJ 37PC00881700) | |
| Enumeration Date | 2014-10-23 |
| Last Update Date | 2022-09-08 |