| NPI | 1154881233 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: IL 180.013246) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: IL 178.013059) |
| Enumeration Date | 2019-03-23 |
| Last Update Date | 2026-07-06 |