| 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 |