| NPI | 1184191512 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: IL 180011854) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CO LPC.0017247) |
| Enumeration Date | 2018-10-24 |
| Last Update Date | 2024-02-14 |