| NPI | 1972662351 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: IL 180-001043) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: IL 15502) |
| 101YM0800X Counselor, Mental Health (Licence: IL 180-001043) | |
| 101YP2500X Counselor, Professional (Licence: IL 180-001043) | |
| Enumeration Date | 2006-12-08 |
| Last Update Date | 2007-07-08 |