| NPI | 1609984764 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: IL 180001207) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: IL 2812) |
| 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: VA 006460) | |
| Enumeration Date | 2006-08-29 |
| Last Update Date | 2024-02-16 |