| NPI | 1447604285 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: IL 178.011581) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: IL 180.011972) |
| 101YM0800X Counselor, Mental Health (Licence: IL 178.011581) | |
| 101YP2500X Counselor, Professional (Licence: IL 180.011972) | |
| Enumeration Date | 2016-04-18 |
| Last Update Date | 2023-02-15 |