| NPI | 1437120680 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: IL 180.001399) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: IL 1683) |
| 101YM0800X Counselor, Mental Health (Licence: IL 180.001399) | |
| Enumeration Date | 2006-01-27 |
| Last Update Date | 2024-07-10 |