| NPI | 1467870337 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: IL 180010921) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: IL 178.009838) |
| Enumeration Date | 2014-03-28 |
| Last Update Date | 2024-01-11 |