| NPI | 1154492957 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: ID LCPC-10469) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: IL 180-004071) |
| Enumeration Date | 2006-11-13 |
| Last Update Date | 2025-07-29 |