| NPI | 1275285140 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: IL 180015714) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: IL 178.016620) |
| Enumeration Date | 2022-01-21 |
| Last Update Date | 2023-12-28 |