| NPI | 1497215396 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL MH26065) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: IL 178014353) |
| 101YP2500X Counselor, Professional (Licence: IL 180013649) | |
| Enumeration Date | 2019-03-25 |
| Last Update Date | 2026-01-21 |