| NPI | 1275252132 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: IL 180.016737) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: IL 178.019286) |
| Enumeration Date | 2022-08-24 |
| Last Update Date | 2025-02-08 |