| NPI | 1831394501 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: NJ 37PC00063700) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: NJ 37PCOOO63700-MAC#5) |
| Enumeration Date | 2007-06-20 |
| Last Update Date | 2007-07-08 |