| NPI | 1548671878 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MI 6401224084) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: IL 178018115) |
| Enumeration Date | 2014-05-08 |
| Last Update Date | 2024-10-17 |