| NPI | 1518159987 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NC 18943) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: IL 180002088) |
| Enumeration Date | 2007-08-09 |
| Last Update Date | 2025-11-06 |