| NPI | 1346489895 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: IL 180.010068) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: MI 6301012652) |
| Enumeration Date | 2009-02-06 |
| Last Update Date | 2016-05-19 |