| NPI | 1497296545 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: CT 002706) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: HI MHC394) |
| 101YP2500X Counselor, Professional (Licence: IL 178.011508) | |
| Enumeration Date | 2017-03-08 |
| Last Update Date | 2017-03-08 |