| NPI | 1376324871 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health |
| Additional Taxonomies | 101YS0200X Counselor School (Licence: IL 2437595) |
| Enumeration Date | 2023-10-10 |
| Last Update Date | 2024-05-22 |