| 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 |