| NPI | 1922551837 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: IL 178.009554) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: IL 23197) |
| Enumeration Date | 2016-07-27 |
| Last Update Date | 2016-07-27 |