| NPI | 1093331068 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: IL 149.024394) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: IL 36009) |
| 104100000X Social Worker (Licence: IL 150.104126) | |
| Enumeration Date | 2020-06-24 |
| Last Update Date | 2022-09-03 |