| NPI | 1053878983 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: IL 178013192) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: IL 178013192) |
| Enumeration Date | 2019-02-27 |
| Last Update Date | 2019-02-27 |