NPI | 1942693551 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: NJ 37PC00506300) |
Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NJ 37LC00223000) |
Enumeration Date | 2015-03-07 |
Last Update Date | 2015-03-07 |