| NPI | 1578121786 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: IL 180.013928) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: IL 178014478) |
| Enumeration Date | 2019-06-03 |
| Last Update Date | 2023-04-07 |