| NPI | 1124579446 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: AZ LPC-18471) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: IL 180.010511) |
| 101YP2500X Counselor, Professional (Licence: IL 180.010511) | |
| 101YP2500X Counselor, Professional (Licence: AZ LPC-18471) | |
| Enumeration Date | 2016-10-21 |
| Last Update Date | 2024-12-13 |