| NPI | 1366862187 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: IL 180.011260) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: IL 178.009613) |
| Enumeration Date | 2014-04-19 |
| Last Update Date | 2018-04-09 |