| NPI | 1245335157 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: WI 3558) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: IL 180-006474) |
| 101YP2500X Counselor Professional (Licence: WI 3558-125) | |
| Enumeration Date | 2006-09-14 |
| Last Update Date | 2024-07-09 |