| NPI | 1932236213 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225C00000X Rehabilitation Counselor (Licence: IL Certificate 00038259) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CO 4183) |
| 101YP1600X Counselor, Pastoral (Licence: FL LB00074B) | |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CO 6311) | |
| Enumeration Date | 2007-02-27 |
| Last Update Date | 2007-07-23 |