| NPI | 1003316720 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: IL 180012458) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: IL 33398) |
| 101YM0800X Counselor, Mental Health (Licence: IL 178.009416) | |
| Enumeration Date | 2018-02-19 |
| Last Update Date | 2020-09-11 |