| NPI | 1932626991 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: IL 178.015275) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| 101YM0800X Counselor, Mental Health | |
| Enumeration Date | 2017-08-29 |
| Last Update Date | 2022-11-02 |