| 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 |