| NPI | 1114576089 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: IL 180014297) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: IL 178015143) |
| Enumeration Date | 2019-09-04 |
| Last Update Date | 2024-03-04 |