| NPI | 1053911479 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: IL 91079) |
| Additional Taxonomies | 261QP3300X Clinic/Center, Pain |
| Enumeration Date | 2020-10-26 |
| Last Update Date | 2022-08-03 |