| NPI | 1346963386 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: IL 180.016367) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: IL 178.017491) |
| Enumeration Date | 2022-09-23 |
| Last Update Date | 2024-09-20 |