| NPI | 1063958122 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: IL 180.014285) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: IL 178.012136) |
| Enumeration Date | 2017-01-13 |
| Last Update Date | 2022-05-06 |