| NPI | 1619955267 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: IL 180-000692) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: IL 180-000692) |
| Enumeration Date | 2006-01-04 |
| Last Update Date | 2018-10-03 |