| 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 |