| NPI | 1396867420 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 101Y00000X Counselor (Licence: IL 22822) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: IL 22822) |
| Enumeration Date | 2007-04-06 |
| Last Update Date | 2009-04-14 |