| NPI | 1336703370 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: IL 178.014227) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: IL 178.014227) | |
| Enumeration Date | 2019-04-25 |
| Last Update Date | 2023-12-28 |