| NPI | 1265227201 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: IL 149.028942) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: IL 149.028942) |
| 101YM0800X Counselor, Mental Health (Licence: IL 149.028942) | |
| Enumeration Date | 2025-04-10 |
| Last Update Date | 2025-12-17 |