| NPI | 1669837498 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: WI 9199-123) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: IL 32110) |
| 1041C0700X Social Worker Clinical (Licence: IL 149.018425) | |
| Enumeration Date | 2015-12-21 |
| Last Update Date | 2019-05-30 |