| NPI | 1679115349 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: IL 180014182) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: IL 178014846) |
| Enumeration Date | 2019-10-14 |
| Last Update Date | 2022-02-28 |