| NPI | 1619414273 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: IL 180010741) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: IL 180010741) |
| 101YP2500X Counselor, Professional (Licence: IL 180010741) | |
| Enumeration Date | 2017-01-20 |
| Last Update Date | 2026-05-05 |