NPI | 1972510121 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: IL 552) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: IL 180001827) |
Enumeration Date | 2006-08-01 |
Last Update Date | 2007-07-08 |