| NPI | 1629081617 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: IL 4881) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: IL 180-001701) |
| Enumeration Date | 2006-08-14 |
| Last Update Date | 2025-09-11 |