| NPI | 1689966624 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: IL 180.012820) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NC 11706) |
| Enumeration Date | 2011-05-10 |
| Last Update Date | 2020-03-13 |