NPI | 1326264060 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: IL 180-006524) |
Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: IL 180006524) |
101YM0800X Counselor, Mental Health (Licence: IA 001063) | |
101YP2500X Counselor, Professional (Licence: IL 180006524) | |
222Q00000X Developmental Therapist | |
Enumeration Date | 2007-04-18 |
Last Update Date | 2021-07-25 |