| NPI | 1417759853 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: IL 180.018175) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: IL 178.020040) |
| Enumeration Date | 2025-03-26 |
| Last Update Date | 2026-06-06 |