| NPI | 1467227223 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225C00000X Rehabilitation Counselor (Licence: IL 397297) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: IL 17591) |
| 101YP2500X Counselor, Professional (Licence: IL 178.018669) | |
| Enumeration Date | 2023-11-21 |
| Last Update Date | 2023-11-28 |