| NPI | 1386923688 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: IL 26844) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 103TC1900X Psychologist, Counseling | |
| 106H00000X Marriage & Family Therapist | |
| Enumeration Date | 2011-08-04 |
| Last Update Date | 2011-08-04 |