| NPI | 1982923769 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: NJ 37LC00095800) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: NJ 37PC00170000) |
| Enumeration Date | 2010-05-19 |
| Last Update Date | 2014-03-25 |