| NPI | 1447603543 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: IL 180.015324) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: IL 180.015324) |
| 101YM0800X Counselor Mental Health (Licence: IL 178.013762) | |
| 101YM0800X Counselor Mental Health (Licence: MA LMHC10001151) | |
| Enumeration Date | 2016-07-13 |
| Last Update Date | 2023-10-27 |