| NPI | 1295198141 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: IL 180012441) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: IL 178.011630) |
| Enumeration Date | 2016-03-29 |
| Last Update Date | 2019-10-27 |