NPI | 1801147012 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: IL 180.008539) |
Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: IL 30569 CADC) |
101YP2500X Counselor, Professional (Licence: IL 178.007150) | |
Enumeration Date | 2012-09-27 |
Last Update Date | 2013-12-30 |