| NPI | 1487759833 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: IL 180004324) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: IL 180004324) |
| Enumeration Date | 2006-09-13 |
| Last Update Date | 2019-07-01 |