| NPI | 1790339299 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: NJ 44SC05741900) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: NJ 37LC00270500) |
| Enumeration Date | 2019-08-01 |
| Last Update Date | 2019-08-01 |