| NPI | 1225325871 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: IL 180009658) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: IL 178007094) |
| Enumeration Date | 2011-07-05 |
| Last Update Date | 2015-04-27 |