| NPI | 1124419643 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: IL 180009277) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: IL 180009277) |
| 101YM0800X Counselor, Mental Health (Licence: IL 180009277) | |
| 106H00000X Marriage & Family Therapist (Licence: IL 180009277) | |
| Enumeration Date | 2015-02-06 |
| Last Update Date | 2015-02-12 |