| NPI | 1477762052 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: IL 180.007189) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: IL 5848) |
| 101YM0800X Counselor, Mental Health (Licence: IL 178-002766) | |
| Enumeration Date | 2007-05-21 |
| Last Update Date | 2009-04-23 |