| NPI | 1407355225 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: 180.001051) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: IL 180.001051) |
| Enumeration Date | 2018-02-07 |
| Last Update Date | 2018-02-07 |