| NPI | 1245431022 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: IL 180004715) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: IL 180004715) |
| 101YM0800X Counselor, Mental Health (Licence: MO 2007012895) | |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MO 2007012895) | |
| Enumeration Date | 2007-05-30 |
| Last Update Date | 2013-09-10 |