| NPI | 1508314352 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: IL 149027150) |
| Enumeration Date | 2016-09-21 |
| Last Update Date | 2025-01-08 |