| NPI | 1639588478 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: IL 180010290) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: IL 178010135) |
| Enumeration Date | 2014-08-06 |
| Last Update Date | 2024-10-16 |