| NPI | 1366862187 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: IL 180.011260) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: IL 178.009613) |
| 101YM0800X Counselor, Mental Health (Licence: IL 180.011260) | |
| Enumeration Date | 2014-04-19 |
| Last Update Date | 2025-05-21 |