| NPI | 1790273795 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: IL 180009668) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: IL 180.009668) |
| 101YM0800X Counselor, Mental Health (Licence: IL 180.009668) | |
| Enumeration Date | 2018-04-25 |
| Last Update Date | 2020-08-10 |