| NPI | 1548446339 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: IL 108.004298) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: IL 180.004298) |
| Enumeration Date | 2008-01-11 |
| Last Update Date | 2008-08-04 |