NPI | 1124146907 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YP2500X Counselor Professional (Licence: IL 180006501) |
Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: IL 178-003481) |
101YP2500X Counselor Professional (Licence: IL 178-003481) | |
Enumeration Date | 2007-03-27 |
Last Update Date | 2023-11-29 |