| NPI | 1316103898 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: IL 180008827) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: OR C9781) |
| 101YP2500X Counselor, Professional (Licence: OR C9781) | |
| 101YP2500X Counselor, Professional (Licence: IL 180008827) | |
| Enumeration Date | 2008-08-04 |
| Last Update Date | 2025-06-03 |