| NPI | 1356484067 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: IL 180008037) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: IL 180008037) |
| Enumeration Date | 2007-02-14 |
| Last Update Date | 2011-12-07 |