| NPI | 1144516584 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: IL 149.014409) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: IL 149.014409) |
| 103K00000X Behavior Analyst (Licence: IL 149.014409) | |
| 251S00000X Community/Behavioral Health (Licence: IL 149.014409) | |
| Enumeration Date | 2011-06-23 |
| Last Update Date | 2011-06-23 |