| NPI | 1356708705 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: IL 180.016824) |
| Additional Taxonomies | 101Y00000X Counselor |
| 101YM0800X Counselor, Mental Health (Licence: IL 180.016824) | |
| 101YP2500X Counselor, Professional (Licence: MO 2024049053) | |
| Enumeration Date | 2016-01-15 |
| Last Update Date | 2026-07-23 |