| NPI | 1770352072 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: IL 149.026097) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: IL 35594) |
| 175T00000X Peer Specialist (Licence: IL 31738) | |
| Enumeration Date | 2023-12-27 |
| Last Update Date | 2023-12-27 |