| NPI | 1932619061 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: IL 32998) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: IL 32998) |
| 101YM0800X Counselor, Mental Health (Licence: IL 32998) | |
| 1041C0700X Social Worker, Clinical (Licence: IL 149026725) | |
| Enumeration Date | 2017-10-03 |
| Last Update Date | 2024-12-30 |