| NPI | 1194156729 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: IL 180008673) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: IL 180.008673) |
| Enumeration Date | 2013-12-08 |
| Last Update Date | 2025-03-11 |