NPI | 1669739579 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: IL 180.010315) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health |
Enumeration Date | 2012-04-16 |
Last Update Date | 2018-07-02 |