| NPI | 1619405529 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: 178011416) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: IL 178008337) |
| Enumeration Date | 2017-05-23 |
| Last Update Date | 2018-06-16 |