NPI | 1922438662 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 104100000X Social Worker (Licence: IL 150.107571) |
Additional Taxonomies | 101Y00000X Counselor (Licence: IL 150.107571) |
101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: IL 150.107571) | |
101YM0800X Counselor, Mental Health (Licence: IL 150.107571) | |
Enumeration Date | 2013-11-15 |
Last Update Date | 2022-09-27 |