| NPI | 1245848134 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NC 16025) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: IL 178014256) |
| 101YM0800X Counselor, Mental Health | |
| 101YP2500X Counselor, Professional (Licence: IL 178014256) | |
| 101YP2500X Counselor, Professional (Licence: SC TLC267PC) | |
| Enumeration Date | 2020-07-17 |
| Last Update Date | 2022-12-09 |