| NPI | 1386796027 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: IL 180004610) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: IL 180-004610) |
| Enumeration Date | 2007-01-16 |
| Last Update Date | 2019-07-15 |