| NPI | 1821646340 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: NJ 37LC00297100) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NJ 44SL06461900) |
| 1041S0200X Social Worker School (Licence: NJ 1024881) | |
| Enumeration Date | 2019-08-28 |
| Last Update Date | 2019-08-28 |