| NPI | 1356748578 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: AZ LPC-23438) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: IL 180011693) |
| Enumeration Date | 2014-12-03 |
| Last Update Date | 2025-05-26 |