| NPI | 1528333200 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL MH14881) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: IL 180008139) |
| 101YP2500X Counselor, Professional (Licence: IL 180008139) | |
| Enumeration Date | 2012-03-14 |
| Last Update Date | 2025-12-22 |