| NPI | 1609324607 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: IL 180.010535) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: IL 180.010535) |
| 101Y00000X Counselor (Licence: IL 180.010535) | |
| 101YP2500X Counselor, Professional (Licence: IL 180.010535) | |
| Enumeration Date | 2016-09-19 |
| Last Update Date | 2018-05-21 |