| NPI | 1265075360 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: IL 180.011867) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NY 009359) |
| Enumeration Date | 2019-10-21 |
| Last Update Date | 2019-10-21 |