| NPI | 1659793545 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: IL 180-003570) |
| Additional Taxonomies | 101Y00000X Counselor |
| 101Y00000X Counselor (Licence: IL 180003570) | |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: IL 27610) | |
| Enumeration Date | 2014-01-10 |
| Last Update Date | 2022-06-14 |