| NPI | 1255525507 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: IL 180.003858) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: IL 12855) |
| 101YM0800X Counselor Mental Health (Licence: IL 180.003858) | |
| Enumeration Date | 2007-08-29 |
| Last Update Date | 2009-05-04 |