| NPI | 1396939120 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: IL 149-003593) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: IL 149-003593) |
| 101YP2500X Counselor, Professional (Licence: IL 149-003593) | |
| Enumeration Date | 2007-09-05 |
| Last Update Date | 2013-04-10 |