| NPI | 1568841468 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: IL 27692) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: IL 24533) |
| 101YP2500X Counselor, Professional | |
| Enumeration Date | 2015-05-26 |
| Last Update Date | 2024-02-14 |