| NPI | 1699985523 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: IL 149-001916) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: IL 3700) |
| 106H00000X Marriage & Family Therapist (Licence: IL 166-000230) | |
| Enumeration Date | 2007-05-22 |
| Last Update Date | 2013-01-31 |