| NPI | 1649715962 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: IL 180012507) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: IL 178012601) |
| Enumeration Date | 2016-12-21 |
| Last Update Date | 2023-08-08 |