| NPI | 1780087569 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: IL 180011717) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: IL 180.011717) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: IL 178006683) | |
| 101YP2500X Counselor, Professional (Licence: IL 178006683) | |
| Enumeration Date | 2014-10-07 |
| Last Update Date | 2019-01-02 |