| NPI | 1962092239 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NJ 37LC00364700) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NJ 37CA00165400) |
| Enumeration Date | 2021-01-21 |
| Last Update Date | 2024-07-22 |