| NPI | 1194879171 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: IL 14446) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: IL 149-009318) |
| Enumeration Date | 2007-01-23 |
| Last Update Date | 2007-07-08 |