| NPI | 1003179185 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: IL 180.009520) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: IL 180.009520) |
| 101YA0400X Counselor Addiction (Substance Use Disorder) | |
| 101YM0800X Counselor Mental Health | |
| Enumeration Date | 2012-06-22 |
| Last Update Date | 2023-11-13 |