| NPI | 1487466223 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: IL 180.016485) |
| Additional Taxonomies | 101YS0200X Counselor School (Licence: IL 2456454) |
| Enumeration Date | 2025-01-20 |
| Last Update Date | 2025-02-12 |