| NPI | 1629200795 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: IL 24817) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: IL 178.004157) |
| Enumeration Date | 2009-08-21 |
| Last Update Date | 2011-08-11 |