NPI | 1972722627 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: NJ 37PC00302600) |
Additional Taxonomies | 103TA0400X Psychologist, Addiction (Substance Use Disorder) |
Enumeration Date | 2007-04-24 |
Last Update Date | 2009-05-28 |