| NPI | 1164027686 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: OR C7431) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: IL 178016072) |
| 101YP2500X Counselor, Professional (Licence: OR C7431) | |
| 101YP2500X Counselor, Professional (Licence: IL 178016072) | |
| Enumeration Date | 2020-12-02 |
| Last Update Date | 2024-11-06 |