| NPI | 1891793691 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: NJ 37LC00015200) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: NJ 37LC00015200) |
| 1041C0700X Social Worker Clinical (Licence: NJ 37LC00015200) | |
| 1041S0200X Social Worker School (Licence: NJ 00334333) | |
| Enumeration Date | 2005-07-14 |
| Last Update Date | 2007-07-08 |