| NPI | 1487090031 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: IL 178.007725) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MS 2101) |
| Enumeration Date | 2013-05-21 |
| Last Update Date | 2016-08-26 |