| NPI | 1023748381 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: IL LPC-178.021660) |
| Additional Taxonomies | 106S00000X Behavior Technician (Licence: IL RBT-22-212697) |
| Enumeration Date | 2022-06-10 |
| Last Update Date | 2025-06-16 |