| NPI | 1831212810 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: IL 12001) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: IL 146-005492) |
| Enumeration Date | 2007-04-06 |
| Last Update Date | 2007-07-08 |