| NPI | 1750409165 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: IL 180.003531) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: IL 180-003531) |
| 101YM0800X Counselor, Mental Health (Licence: IL 180-003531) | |
| Enumeration Date | 2007-03-26 |
| Last Update Date | 2019-11-14 |