| NPI | 1619535002 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: IA 094835) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: IL 33810) |
| 101YP2500X Counselor, Professional (Licence: IL 178.010795) | |
| Enumeration Date | 2019-05-31 |
| Last Update Date | 2019-05-31 |