| NPI | 1477089290 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: IL 149.021624) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: IL 23393) |
| 405300000X Prevention Professional (Licence: IL 22083) | |
| Enumeration Date | 2017-05-11 |
| Last Update Date | 2022-04-09 |