| NPI | 1518208404 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: IL 180.014245) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: IL 37590) |
| 101YM0800X Counselor, Mental Health (Licence: FL MH17097) | |
| 163WP0808X Registered Nurse, Psych/Mental Health (Licence: IL 041514573) | |
| Enumeration Date | 2013-03-03 |
| Last Update Date | 2024-09-10 |