| NPI | 1598989204 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: IL 178.004809) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: IL 212936) |
| Enumeration Date | 2007-04-12 |
| Last Update Date | 2007-07-16 |