| NPI | 1548593734 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health |
| Additional Taxonomies | 101Y00000X Counselor |
| 251S00000X Community/Behavioral Health (Licence: IL 180008585) | |
| Enumeration Date | 2009-09-07 |
| Last Update Date | 2014-11-06 |