| NPI | 1073090122 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: IL 180.011527) |
| Additional Taxonomies | 225C00000X Rehabilitation Counselor |
| Enumeration Date | 2018-07-22 |
| Last Update Date | 2023-01-31 |