| NPI | 1578134425 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MO 2023038331) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: IL 149.028195) |
| 101YM0800X Counselor, Mental Health | |
| Enumeration Date | 2021-07-01 |
| Last Update Date | 2024-12-12 |