| NPI | 1417792623 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225C00000X Rehabilitation Counselor (Licence: 65571) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: IL 180.007568) |
| 101YP2500X Counselor, Professional (Licence: IL 180.007568) | |
| Enumeration Date | 2024-06-28 |
| Last Update Date | 2024-06-28 |