| NPI | 1295111342 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: IL 178.011109) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: IL 178.011109) |
| Enumeration Date | 2015-07-30 |
| Last Update Date | 2016-07-26 |