| NPI | 1538422035 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: TX 85452) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: OH ICDC.121089) |
| 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: IL 34373) | |
| 101YP2500X Counselor Professional (Licence: OH E.0602226) | |
| 101YP2500X Counselor Professional (Licence: IL 180.010841) | |
| Enumeration Date | 2012-06-19 |
| Last Update Date | 2023-05-26 |