| NPI | 1285084202 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: CO LPC.0013996) |
| Additional Taxonomies | 283Q00000X Psychiatric Hospital (Licence: IL 180.010048) |
| Enumeration Date | 2016-06-21 |
| Last Update Date | 2018-07-31 |