| NPI | 1659042216 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: AZ 16099) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: AZ 13341) |
| 101YP2500X Counselor, Professional (Licence: IL 178.017400) | |
| Enumeration Date | 2021-09-23 |
| Last Update Date | 2023-05-09 |