| NPI | 1427880210 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: IL 178.021518) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: IL 178.021518) |
| Enumeration Date | 2024-08-19 |
| Last Update Date | 2025-07-10 |