| NPI | 1689354151 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: IL 178016802) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: IL 36644) |
| 101YM0800X Counselor, Mental Health (Licence: IL 178016802) | |
| 101YP2500X Counselor, Professional (Licence: IL 1228639) | |
| Enumeration Date | 2023-07-20 |
| Last Update Date | 2023-07-20 |