| NPI | 1215609797 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: IL 180.010642) |
| Additional Taxonomies | 101YP2500X Counselor, Professional |
| Enumeration Date | 2021-10-01 |
| Last Update Date | 2022-02-23 |