| NPI | 1699507426 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: IL 37222) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: IL 37222) |
| Enumeration Date | 2024-08-19 |
| Last Update Date | 2024-08-19 |