NPI | 1306083902 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: IL 180007062) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: IL 180007062) |
Enumeration Date | 2009-01-19 |
Last Update Date | 2009-01-19 |