| NPI | 1750713368 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: IL 150.010429) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: IL 21137) |
| Enumeration Date | 2013-08-06 |
| Last Update Date | 2015-07-28 |