| NPI | 1720904154 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: IL 149026938) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: IL 149026938) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: IL 149026938) | |
| Enumeration Date | 2026-06-29 |
| Last Update Date | 2026-06-29 |