| NPI | 1164512182 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: IL 180003164) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: IL 180-003164) |
| Enumeration Date | 2006-10-13 |
| Last Update Date | 2023-06-23 |