| NPI | 1679622906 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: IL 180001184) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: IN 39002098A) |
| Enumeration Date | 2007-01-09 |
| Last Update Date | 2009-09-28 |