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 |