| NPI | 1154072064 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: IL 180.016322) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 101YP2500X Counselor, Professional (Licence: IL 178.018131) | |
| Enumeration Date | 2022-01-12 |
| Last Update Date | 2024-08-23 |