| NPI | 1578903696 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MN 899) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: IL 180008697) |
| Enumeration Date | 2013-07-03 |
| Last Update Date | 2014-11-26 |