| NPI | 1982772539 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: PA PC005168) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NJ 37LC00082100) |
| 101YM0800X Counselor, Mental Health (Licence: NJ 37PC00002000) | |
| Enumeration Date | 2006-12-01 |
| Last Update Date | 2020-06-08 |