| NPI | 1679607584 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: IL 180.001468) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: IL 180.001468) |
| 101YP2500X Counselor, Professional (Licence: IL 180-001468) | |
| Enumeration Date | 2007-03-15 |
| Last Update Date | 2023-11-13 |