| NPI | 1295900306 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: IL 180009152) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WA LH00010913) |
| Enumeration Date | 2008-04-29 |
| Last Update Date | 2014-08-05 |