| NPI | 1497982151 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: IL 180-007240) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: IL 25596) |
| 101YM0800X Counselor Mental Health | |
| Enumeration Date | 2009-06-19 |
| Last Update Date | 2023-01-30 |