| NPI | 1700204369 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: IL 178.008701) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: IL 178.008701) |
| Enumeration Date | 2014-04-01 |
| Last Update Date | 2014-04-01 |