| NPI | 1679641120 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MO 005034) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: IL 149010633) |
| Enumeration Date | 2006-12-01 |
| Last Update Date | 2007-07-08 |