| NPI | 1518091669 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CO LPC.0015516) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: IL 180-004314) |
| Enumeration Date | 2007-03-14 |
| Last Update Date | 2019-08-04 |