| NPI | 1306348016 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: IL 35368) |
| Additional Taxonomies | 167G00000X Licensed Psychiatric Technician (Licence: IL 2009-082) |
| 183700000X Pharmacy Technician (Licence: IL 049.246255) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2018-03-08 |
| Last Update Date | 2023-07-02 |