| NPI | 1265446652 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: IL LCPC 180-001087) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: IL 180001087) |
| Enumeration Date | 2006-07-28 |
| Last Update Date | 2024-12-04 |