NPI | 1013369628 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: IL 180.011349) |
Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: IL 32660) |
101YP2500X Counselor, Professional (Licence: MO 2018007090) | |
Enumeration Date | 2016-07-07 |
Last Update Date | 2024-07-27 |