| NPI | 1457770356 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: UT 12689912-3501) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: IL 30983) |
| 1041C0700X Social Worker, Clinical (Licence: IL 149.017322) | |
| Enumeration Date | 2014-04-08 |
| Last Update Date | 2022-09-13 |