| NPI | 1376890756 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: IL 180008233) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: IL 180008233) |
| 101YM0800X Counselor, Mental Health (Licence: IL 180008233) | |
| Enumeration Date | 2012-08-05 |
| Last Update Date | 2012-08-09 |