| NPI | 1114549169 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: IL 180.015887) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: IL 178.015933) |
| Enumeration Date | 2020-05-13 |
| Last Update Date | 2025-04-09 |