| NPI | 1346681350 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: IL 149018354) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: IL 28068) |
| 1041C0700X Social Worker, Clinical (Licence: IL 149022364) | |
| Enumeration Date | 2013-07-08 |
| Last Update Date | 2023-07-11 |