| NPI | 1154668515 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MI 6401018853) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: IL 180.009518) |
| Enumeration Date | 2013-01-04 |
| Last Update Date | 2026-04-22 |