| NPI | 1609941459 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: IL 180.006074) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: IL 16812) |
| 101YM0800X Counselor Mental Health (Licence: IL 180.006074) | |
| Enumeration Date | 2006-11-21 |
| Last Update Date | 2015-03-23 |