| NPI | 1134423742 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: IL 21082) |
| Additional Taxonomies | 103K00000X Behavior Analyst |
| Enumeration Date | 2010-12-23 |
| Last Update Date | 2020-04-14 |